Repeated Artemisinin-Based Combination Therapies in a Malaria Hyperendemic Area of Mali: Efficacy, Safety, and Public Health Impact

Issaka Sagara (1) , Bakary Fofana (2) , Jean Gaudart (1, 3) , Bakary Sidibe (2) , Amadou Togo (4) , Sekou Toure (5) , Kassim Sanogo (6) , Demba Dembele (7) , Alassane Dicko (8) , Roch Giorgi (1) , Ogobara K Doumbo (8) , Abdoulaye A Djimdé (2)

1 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
2 Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy, and Odontostomatology
3 AMU - Aix Marseille Université
4 Université Bordeaux Segalen - Bordeaux 2
5 UM2 - Université Montpellier 2 - Sciences et Techniques
6 Chercheur indépendant
7 IGBMC - Institut de Génétique et de Biologie Moléculaire et Cellulaire
8 MRTC - Malaria Research and Training Center

Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.

Domains: Mathematics [math]; Dynamical Systems [math.DS]; Mathematics [math]; Probability [math.PR]; Statistics [stat]; Applications [stat.AP]; Statistics [stat]; Methodology [stat.ME]; Mathematics [math]; Statistics [math.ST]; Environmental Sciences; Environmental and Society; Life Sciences [q-bio]; Ecology, environment; Health; Life Sciences [q-bio]; Human health and pathology; Infectious diseases; Life Sciences [q-bio]; Human health and pathology; Emerging diseases; Life Sciences [q-bio]; Microbiology and Parasitology; Parasitology; Life Sciences [q-bio]; Santé publique et épidémiologie

Issaka Sagara, Bakary Fofana, Jean Gaudart, Bakary Sidibe, Amadou Togo, et al.. Repeated Artemisinin-Based Combination Therapies in a Malaria Hyperendemic Area of Mali: Efficacy, Safety, and Public Health Impact. American Journal of Tropical Medicine and Hygiene, 2012, ⟨10.4269/ajtmh.2012.11-0649⟩. ⟨hal-01307775⟩