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
Issued Date
2005-09-22
Resource Type
ISSN
14752875
14752875
14752875
Other identifier(s)
2-s2.0-26844556914
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Mahidol University
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SCOPUS
Bibliographic Citation
Malaria Journal. Vol.4, (2005)
Suggested Citation
Robert Hutagalung, Lucy Paiphun, Elizabeth A. Ashley, Rose McGready, Alan Brockman, Kaw L. Thwai, Pratap Singhasivanon, Thomas Jelinek, Nicholas J. White, François H. Nosten 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. Malaria Journal. Vol.4, (2005). doi:10.1186/1475-2875-4-46 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/16552
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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
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. © 2005 Hutagalung et al; licensee BioMed Central Ltd.