Publication: Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: A randomized trial
Issued Date
2007-05-18
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ISSN
15555887
Other identifier(s)
2-s2.0-34249862105
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Mahidol University
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SCOPUS
Bibliographic Citation
PLoS Clinical Trials. Vol.2, No.5 (2007)
Suggested Citation
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 Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: A randomized trial. PLoS Clinical Trials. Vol.2, No.5 (2007). doi:10.1371/journal.pctr.0020020 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/24869
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Title
Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: A randomized trial
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.