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Title: Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: A randomized trial
Authors: Moses R. Kamya
Adoke Yeka
Hasifa Bukirwa
Myers Lugemwa
John B. Rwakimari
Sarah G. Staedke
Ambrose O. Talisuna
Bryan Greenhouse
François Nosten
Philip J. Rosenthal
Fred Wabwire-Mangen
Grant Dorsey
Makerere University
Uganda Malaria Surveillance Project
Uganda Ministry of Health
London School of Hygiene & Tropical Medicine
University of California, San Francisco
Mahidol University
Mekerere University
Keywords: Medicine
Issue Date: 18-May-2007
Citation: PLoS Clinical Trials. Vol.2, No.5 (2007)
Abstract: Objectives: To compare the efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) for treating uncomplicated falciparum malaria in Uganda. Design: Randomized single-blinded clinical trial. Setting: Apac, Uganda, an area of very high malaria transmission intensity. Participants: Children aged 6 mo to 10 y with uncomplicated falciparum malaria. Intervention: Treatment of malaria with AL or DP, each following standard 3-d dosing regimens. Outcome measures: Risks of recurrent parasitemia at 28 and 42 d, unadjusted and adjusted by genotyping to distinguish recrudescences and new infections. Results: Of 421 enrolled participants, 417 (99%) completed follow-up. The unadjusted risk of recurrent falciparum parasitemia was significantly lower for participants treated with DP than for those treated with AL after 28 d (11 % versus 29%, risk difference [RD] 18%, 95% confidence interval [CI] 11%-26%) and 42 d (43% versus 53%; RD 9.6%, 95% CI 0%-19%) of follow-up. Similarly, the risk of recurrent parasitemia due to possible recrudescence (adjusted by genotyping) was significantly lower for participants treated with DP than for those treated with AL after 28 d (1.9% versus 8.9%; RD 7.0%, 95% CI 2.5%-12%) and 42 d (6.9% versus 16%; RD 9.5%,95% CI 2.8%-16%). Patients treated with DP had a lower risk of recurrent parasitemia due to non-falciparum species, development of gametocytemia, and higher mean increase in hemoglobin compared to patients treated with AL. Both drugs were well tolerated; serious adverse events were uncommon and unrelated to study drugs. Conclusion: DP was superior to AL for reducing the risk of recurrent parasitemia and gametocytemia, and provided improved hemoglobin recovery. DP thus appears to be a good alternative to AL as first-line treatment of uncomplicated malaria in Uganda. To maximize the benefit of artemisinin-based combination therapy in Africa, treatment should be integrated with aggressive strategies to reduce malaria transmission intensity.
ISSN: 15555887
Appears in Collections:Scopus 2006-2010

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