ISSN 2756-3391
African Journal of Parasitology Research ISSN: 2756-3391 Vol. 11 (3), pp. 001-011, March, 2023. © International Scholars Journals
Full Length Research Paper
Artemether-Lumefantrine and Artesunate-Amodiaquine in routine use for the treatment of uncomplicated Plasmodium falciparum malaria in Senegal: Open randomized efficacy trial
Khadime Sylla*, Cheikh Binetou Fall, Souleye Lelo, Isaac Akhenaton Manga, Doudou Sow, Magatte Ndiaye, Kuaku Folly, Roger C.K Tine and Babacar Faye
Department of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, University Cheikh Anta DIOP of Dakar (UCAD).
Received 30 November, 2022; Accepted 20 March, 2023
Abstract
Background: Prompt treatment of malaria attacks with artemisinin-based combination therapy (ACT) is an essential tool for malaria control. Several ACTs are currently being used in Senegal. A surveillance system aimed at monitoring antimalarial drug efficacy is established. This study was conducted to assess the efficacy of Artemether-Lumefantrine (AL) and Artesunate-Amodiaquine (ASAQ) under routine conditions. Methods: An open randomized trial was carried out during three malaria transmission seasons (2014 to 2016) in five malaria sentinel sites. The 2009 WHO protocol for antimalarial drug efficacy was used. The study end points included (i) PCR corrected adequate clinical and parasitological response (ACPR) at day 28, (ii) parasites and fever clearance time. Intention to treat (ITT) and per-protocol (PP) analysis were done. Results: Overall, 1118 patients with uncomplicated Plasmodium falciparum malaria were randomized to receive either AL (n=553) or ASAQ (n=565). In ITT analysis, PCR corrected ACPR at day 28 was at 96.1% [95%CI (88 – 99.9)] in the AL arm and 95.6% [95% CI (87.7 - 99.9)] in the ASAQ arm (p=0.7). PP analysis at day 28 showed 99.4% efficacy for both groups. Parasite clearance time and fever clearance time remained constant over the three transmission seasons and were obtained at 72 hours in both arms of the trial. Conclusion: Under operational conditions in Senegal, AL and ASAQ are still highly effective for the treatment of uncomplicated P. falciparum malaria. However, it’s crucial to continue monitoring the efficacy of the drugs to further guide malaria treatment policy.
Keywords: Artemether–Lumefantrine, Artesunate–Amodiaquine, Efficacy, Plasmodium falciparum, Malaria, Senegal.