Publication: A randomized trial of artemether-lumefantrine versus mefloquine-artesunate for the treatment of uncomplicated multi-drug resistant Plasmodium falciparum on the western border of Thailand
1
Accepted Date
2005-09-22
Issued Date
2005-09
Copyright Date
2005
Resource Type
Language
eng
ISSN
1475-2875 (electronic)
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic Citation
Hutagalung R, Paiphun L, Ashley EA, McGready R, Brockman A, Thwai KL, et al. A randomized trial of
artemether-lumefantrine versus mefloquine-artesunate for the treatment of
uncomplicated multi-drug resistant Plasmodium falciparum on the western border of
Thailand. Malar J. 2005 Sep 22;4:46.
Suggested Citation
Hutagalung, Robert, Paiphun, Lucy, Ashley, Elizabeth A., McGready, Rose, Brockman, Alan, Thwai, Kaw L., Pratap Singhasivanon, ประตาป สิงหศิวานนท์, Jelinek, Thomas, White, Nicholas J., Nosten, François H. A randomized trial of artemether-lumefantrine versus mefloquine-artesunate for the treatment of uncomplicated multi-drug resistant Plasmodium falciparum on the western border of Thailand. Hutagalung R, Paiphun L, Ashley EA, McGready R, Brockman A, Thwai KL, et al. A randomized trial of
artemether-lumefantrine versus mefloquine-artesunate for the treatment of
uncomplicated multi-drug resistant Plasmodium falciparum on the western border of
Thailand. Malar J. 2005 Sep 22;4:46.. doi:10.1186/1475-2875-4-46 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/694
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Title
A randomized trial of artemether-lumefantrine versus mefloquine-artesunate for the treatment of uncomplicated multi-drug resistant Plasmodium falciparum on the western border of Thailand
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Abstract
BACKGROUND: The use of antimalarial drug combinations with artemisinin
derivatives is recommended to overcome drug resistance in Plasmodium falciparum.
The fixed combination of oral artemether-lumefantrine, an artemisinin combination
therapy (ACT) is highly effective and well tolerated. It is the only registered
fixed combination containing an artemisinin. The trial presented here was
conducted to monitor the efficacy of the six-dose regimen of
artemether-lumefantrine (ALN) in an area of multi-drug resistance, along the
Thai-Myanmar border.
METHODS: The trial was an open-label, two-arm, randomized study comparing
artemether-lumefantrine and mefloquine-artesunate for the treatment of
uncomplicated falciparum malaria with 42 days of follow up. Parasite genotyping
by polymerase chain reaction (PCR) was used to distinguish recrudescent from
newly acquired P. falciparum infections. The PCR adjusted cure rates were
evaluated by survival analysis.
RESULTS: In 2001-2002 a total of 490 patients with slide confirmed uncomplicated
P. falciparum malaria were randomly assigned to receive artemether-lumefantrine
(n = 245) or artesunate and mefloquine (n = 245) and were followed for 42 days.
All patients had rapid initial clinical and parasitological responses. In both
groups, the PCR adjusted cure rates by day 42 were high: 98.8% (95% CI 96.4,
99.6%) for artemether-lumefantrine and 96.3% (95% CI 93.1, 98.0%) for
artesunate-mefloquine. Both regimens were very well tolerated with no serious
adverse events observed attributable to either combination.
CONCLUSION: Overall, this study confirms that these two artemisinin-based
combinations remain highly effective and result in equivalent therapeutic
responses in the treatment of highly drug-resistant falciparum malaria.