Publication: Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast.
Accepted Date
2011-09-15
Issued Date
2011
Copyright Date
2011
Resource Type
Language
eng
ISSN
1932-6203 (electronic)
Rights
Mahidol University
Rights Holder(s)
PubMed Central
Bibliographic Citation
Borrmann S, Sasi P, Mwai L, Bashraheil M, Abdallah A, Muriithi S. et al. Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast. PLoS One. 2011;6(11):e26005.
Suggested Citation
Borrmann, Steffen, Sasi, Philip, Mwai, Leah, Bashraheil, Mahfudh, Abdallah, Ahmed, Muriith, Steven, Frühauf, Henrike, Schaub, Barbara, Pfeil, Johannes, Peshu, Judy, Warunee Hanpithakpong, วารุณี หาญพิทักษ์พงศ์, Rippert, Anja, Juma, Elizabeth, Tsofa, Benjamin, Mosobo, Moses, Lowe, Brett, Osier, Faith, Fegan, Greg, Lindegårdh, Niklas, Nzila, Alexis, Peshu, Norbert, Mackinnon, Margaret, Marsh, Kevin Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast.. Borrmann S, Sasi P, Mwai L, Bashraheil M, Abdallah A, Muriithi S. et al. Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast. PLoS One. 2011;6(11):e26005.. doi:10.1371/journal.pone.0026005. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/799
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Title
Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast.
Author(s)
Borrmann, Steffen
Sasi, Philip
Mwai, Leah
Bashraheil, Mahfudh
Abdallah, Ahmed
Muriith, Steven
Frühauf, Henrike
Schaub, Barbara
Pfeil, Johannes
Peshu, Judy
Warunee Hanpithakpong
วารุณี หาญพิทักษ์พงศ์
Rippert, Anja
Juma, Elizabeth
Tsofa, Benjamin
Mosobo, Moses
Lowe, Brett
Osier, Faith
Fegan, Greg
Lindegårdh, Niklas
Nzila, Alexis
Peshu, Norbert
Mackinnon, Margaret
Marsh, Kevin
Sasi, Philip
Mwai, Leah
Bashraheil, Mahfudh
Abdallah, Ahmed
Muriith, Steven
Frühauf, Henrike
Schaub, Barbara
Pfeil, Johannes
Peshu, Judy
Warunee Hanpithakpong
วารุณี หาญพิทักษ์พงศ์
Rippert, Anja
Juma, Elizabeth
Tsofa, Benjamin
Mosobo, Moses
Lowe, Brett
Osier, Faith
Fegan, Greg
Lindegårdh, Niklas
Nzila, Alexis
Peshu, Norbert
Mackinnon, Margaret
Marsh, Kevin
Corresponding Author(s)
Abstract
BACKGROUND: The emergence of artemisinin-resistant P. falciparum malaria in
South-East Asia highlights the need for continued global surveillance of the
efficacy of artemisinin-based combination therapies.
METHODS: On the Kenyan coast we studied the treatment responses in 474 children
6-59 months old with uncomplicated P. falciparum malaria in a randomized
controlled trial of dihydroartemisinin-piperaquine vs. artemether-lumefantrine
from 2005 to 2008. (ISRCTN88705995).
RESULTS: The proportion of patients with residual parasitemia on day 1 rose from
55% in 2005-2006 to 87% in 2007-2008 (odds ratio, 5.4, 95%CI, 2.7-11.1; P<0.001)
and from 81% to 95% (OR, 4.1, 95%CI, 1.7-9.9; P = 0.002) in the DHA-PPQ and AM-LM
groups, respectively. In parallel, Kaplan-Meier estimated risks of apparent
recrudescent infection by day 84 increased from 7% to 14% (P = 0.1) and from 6%
to 15% (P = 0.05) with DHA-PPQ and AM-LM, respectively. Coinciding with
decreasing transmission in the study area, clinical tolerance to parasitemia
(defined as absence of fever) declined between 2005-2006 and 2007-2008 (OR body
temperature >37.5°C, 2.8, 1.9-4.1; P<0.001). Neither in vitro sensitivity of
parasites to DHA nor levels of antibodies against parasite extract accounted for
parasite clearance rates or changes thereof.
CONCLUSIONS: The significant, albeit small, decline through time of
parasitological response rates to treatment with ACTs may be due to the emergence
of parasites with reduced drug sensitivity, to the coincident reduction in
population-level clinical immunity, or both. Maintaining the efficacy of
artemisinin-based therapy in Africa would benefit from a better understanding of
the mechanisms underlying reduced parasite clearance rates.
TRIAL REGISTRATION: Controlled-Trials.com ISRCTN88705995.