Adjei George O, Goka Bamenla Q, Enweronu-Laryea Christabel C, Rodrigues Onike P, Renner Lorna, Sulley Abdul M, Alifrangis Michael, Khalil Insaf, Kurtzhals Jorgen A
Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana.
Malar J. 2014 Sep 19;13:369. doi: 10.1186/1475-2875-13-369.
Sickle cell disease (SCD) is a genetic disorder common in malaria endemic areas. In endemic areas, malaria is a major cause of morbidity and mortality among SCD patients. This suggests the need for prompt initiation of efficacious anti-malarial therapy in SCD patients with acute malaria. However, there is no information to date, on the efficacy or safety of artemisinin combination therapy when used for malaria treatment in SCD patients.
Children with SCD and acute uncomplicated malaria (n=60) were randomized to treatment with artesunate-amodiaquine (AA), or artemether-lumefantrine (AL). A comparison group of non-SCD children (HbAA genotype; n=59) with uncomplicated malaria were also randomized to treatment with AA or AL. Recruited children were followed up and selected investigations were done on days 1, 2, 3, 7, 14, 28, 35, and 42. Selected clinical and laboratory parameters of the SCD patients were also compared with a group of malaria-negative SCD children (n=82) in steady state.
The parasite densities on admission were significantly lower in the SCD group, compared with the non-SCD group (p=0.0006). The parasite reduction ratio (PRR) was lower, clearance was slower (p<0.0001), and time for initial parasitaemia to decline by 50 and 90% were longer for the SCD group. Adequate clinical and parasitological response (ACPR) on day 28 was 98.3% (58/59) in the SCD group and 100% (57/57) in the non-SCD group. Corresponding ACPR rates on day 42 were 96.5% (55/57) in the SCD group and 96.4% (53/55) in the non-SCD group. The fractional changes in haemoglobin, platelets and white blood cell counts between baseline (day 0) and endpoint (day 42) were 16.9, 40.6 and 92.3%, respectively, for the SCD group, and, 12.3, 48.8 and 7.5%, respectively, for the non-SCD group. There were no differences in these indices between AA- and AL-treated subjects.
The parasite clearance of SCD children with uncomplicated malaria was slower compared with non-SCD children. AA and AL showed similar clinical and parasitological effects in the SCD and non-SCD groups. The alterations in WBC and platelet counts may have implications for SCD severity.
Current controlled trials ISRCTN96891086.
镰状细胞病（SCD）是疟疾流行地区常见的一种遗传性疾病。在流行地区，疟疾是SCD患者发病和死亡的主要原因。这表明对于患有急性疟疾的SCD患者，需要及时开始有效的抗疟治疗。然而，迄今为止，尚无关于青蒿素联合疗法用于SCD患者疟疾治疗的疗效或安全性的信息。
将患有SCD和急性非复杂性疟疾的儿童（n = 60）随机分为接受青蒿琥酯-阿莫地喹（AA）或蒿甲醚-本芴醇（AL）治疗。另一组患有非复杂性疟疾的非SCD儿童（HbAA基因型；n = 59）也随机分为接受AA或AL治疗。对招募的儿童进行随访，并在第1、2、3、7、14、28、35和42天进行选定的调查。还将SCD患者选定的临床和实验室参数与一组处于稳定状态的疟疾阴性SCD儿童（n = 82）进行比较。
与非SCD组相比，SCD组入院时的寄生虫密度显著更低（p = 0.0006）。SCD组的寄生虫减少率（PRR）更低，清除速度更慢（p < 0.0001），初始寄生虫血症下降50%和90%的时间更长。SCD组在第28天的充分临床和寄生虫学反应（ACPR）为98.3%（58/59），非SCD组为100%（57/57）。SCD组和非SCD组在第42天的相应ACPR率分别为96.5%（55/57）和96.4%（53/55）。SCD组在基线（第0天）和终点（第42天）之间血红蛋白、血小板和白细胞计数的分数变化分别为16.9%、40.6%和92.3%，非SCD组分别为12.3%、48.8%和7.5%。接受AA和AL治疗的受试者在这些指标上没有差异。
与非SCD儿童相比，患有非复杂性疟疾的SCD儿童的寄生虫清除速度较慢。AA和AL在SCD组和非SCD组中显示出相似的临床和寄生虫学效果。白细胞和血小板计数的改变可能对SCD的严重程度有影响。
当前对照试验ISRCTN96891086 。
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