Publication:
In vivo susceptibility of Plasmodium falciparum to artesunate in Binh Phuoc Province, Vietnam.

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tm-ar-white-2012-1.pdf (756.53 KB)

Accepted Date

2012-10-20

Issued Date

2012-10-26

Copyright Date

2012

Resource Type

Research Article

Language

eng

ISSN

1475-2875 (electronic)

DOI

10.1186/1475-2875-11-355

Rights

Mahidol University

Rights Holder(s)

BioMed Central

Bibliographic Citation

Hien TT, Thuy-Nhien NT, Phu NH, Boni MF, Thanh NV, Nha-Ca NT, et al. In vivo susceptibility of Plasmodium falciparum to artesunate in Binh Phuoc Province, Vietnam. Malar J. 2012 Oct 26;11:355.

Suggested Citation

Hien, Tran Tinh, Thuy-Nhien, Nguyen Thanh, Phu, Nguyen Hoan, Boni, Maciej F., Thanh, Ngo Viet, Nha-Ca, Nguyen Thuy, Thai, Le Hong, Thai, Cao Quang, Toi, Pham Van, Thuan, Phung Duc, Long, Le Thanh, Dong, Le Thanh, Merson, Laura, Dolecek, Christiane, Stepniewska, Kasia, Ringwald, Pascal, White, Nicholas J., Farrar, Jeremy, Wolbers, Marcel In vivo susceptibility of Plasmodium falciparum to artesunate in Binh Phuoc Province, Vietnam.. Hien TT, Thuy-Nhien NT, Phu NH, Boni MF, Thanh NV, Nha-Ca NT, et al. In vivo susceptibility of Plasmodium falciparum to artesunate in Binh Phuoc Province, Vietnam. Malar J. 2012 Oct 26;11:355.. doi:10.1186/1475-2875-11-355 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/706

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Title

In vivo susceptibility of Plasmodium falciparum to artesunate in Binh Phuoc Province, Vietnam.

Author(s)

Hien, Tran Tinh
 Thuy-Nhien, Nguyen Thanh
 Phu, Nguyen Hoan
 Boni, Maciej F.
 Thanh, Ngo Viet
 Nha-Ca, Nguyen Thuy
 Thai, Le Hong
 Thai, Cao Quang
 Toi, Pham Van
 Thuan, Phung Duc
 Long, Le Thanh
 Dong, Le Thanh
 Merson, Laura
 Dolecek, Christiane
 Stepniewska, Kasia
 Ringwald, Pascal
 White, Nicholas J.
 Farrar, Jeremy
 Wolbers, Marcel

Corresponding Author(s)

Hien, Tran Tinh

Other Contributor(s)

Mahidol University. Faculty of Tropical Medicine

Abstract

BACKGROUND: By 2009, there were worrying signs from western Cambodia that parasitological responses to artesunate-containing treatment regimens for uncomplicated Plasmodium falciparum malaria were slower than elsewhere which suggested the emergence of artemisinin resistance. Vietnam shares a long land border with Cambodia with a large number of migrants crossing it on a daily basis. Therefore, there is an urgent need to investigate whether there is any evidence of a change in the parasitological response to the artemisinin derivatives in Vietnam. METHODS: From August 2010 to May 2011, a randomized controlled clinical trial in uncomplicated falciparum malaria was conducted to compare two doses of artesunate (AS) (2mg/kg/day versus 4 mg/kg/day for three days) followed by dihydroartemisinin-piperaquine (DHA-PPQ) and a control arm of DHA-PPQ. The goal was characterization of the current efficacy of artesunate in southern Vietnam. The primary endpoint of this study was the parasite clearance half-life; secondary endpoints included the parasite reduction ratios at 24 and 48 hours and the parasite clearance time. RESULTS: 166 patients were recruited into the study. The median parasite clearance half-lives were 3.54 (AS 2mg/kg), 2.72 (AS 4mg/kg), and 2.98 hours (DHA-PPQ) (p=0.19). The median parasite-reduction ratio at 24 hours was 48 in the AS 2mg/kg group compared with 212 and 113 in the other two groups, respectively (p=0.02). The proportions of patients with a parasite clearance time of >72 hours for AS 2mg/kg, AS 4mg/kg and DHA-PPQ were 27%, 27%, and 22%, respectively. Early treatment failure occurred in two (4%) and late clinical failure occurred in one (2%) of the 55 patients in the AS 2mg/kg group, as compared with none in the other two study arms. The PCR-corrected adequate clinical and parasitological response (APCR) rates in the three groups were 94%, 100%, and 100% (p=0.04). CONCLUSIONS: This study demonstrated faster P. falciparum parasite clearance in southern Vietnam than in western Cambodia but slower clearance in comparison with historical data from Vietnam. Further studies to determine whether this represents the emergence of artemisinin resistance in this area are needed. Currently, the therapeutic response to DHA-PPQ remains satisfactory in southern Vietnam.

Keyword(s)

Artesunate
 Parasite clearance half-life
 Parasite clearance of >72 hours
 Parasite reduction ratio
 Plasmodium falciparum
 Open Access article

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https://repository.li.mahidol.ac.th/handle/20.500.14594/706

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