Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
Antimicrob Agents Chemother. 2021 Jul 16;65(8):e0087321. doi: 10.1128/AAC.00873-21.
A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of and were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale.
最近的一项随机对照试验，即 WANECAM（西非抗疟药物临床试验网络）试验，在西非的七个中心进行，发现青蒿琥酯-咯萘啶、青蒿琥酯-阿莫地喹、哌喹-青蒿琥酯和双氢青蒿素-哌喹均显示出良好的疗效。然而，青蒿琥酯-咯萘啶与其他方案相比，临床发作之间的间隔更短。在对这些治疗方法的进一步比较中，我们通过定量 PCR（qPCR）在马里和布基纳法索的 5 个地点的 WANECAM 参与者中发现了治疗后 72 小时持续亚微观寄生虫血症的病例，并且我们比较了该组与 72 小时内完全清除寄生虫的治疗结果。在 552 名可评估的患者中，17.7%在首次治疗发作期间的 72 小时内 qPCR 检测到寄生虫血症。这一比例在不同的地点有所不同，反映了疟疾传播强度的差异，但在 pooled drug treatment groups 中没有差异。然而，在 72 小时时接受青蒿琥酯-咯萘啶且 qPCR 阳性的患者在第 42 天发生显微镜下可检测到的复发性疟原虫寄生虫血症的可能性明显高于接受其他方案的患者，并且在下次临床发作之前经历的间隔更短。还评估了 的单倍型和 的单倍型在持续寄生虫中。这些数据表明，青蒿琥酯-咯萘啶在西非的寄生虫学疗效可能受到威胁，这是它首次大规模引入十多年后的情况。
