Artemisinin-Piperaquine versus Artemether-Lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Grande Comore Island: an open-label, non-randomized controlled trial

Elsevier

Available online 18 August 2022, 106658

International Journal of Antimicrobial AgentsHighlights•

Both artemisinin-piperaquine and artemether-lumefantrine maintained their high efficacy during the treatment of falciparum malaria in Grande Comore Island.

Artemisinin-piperaquine in combination with anti-gametocyte treatment was recommended for the rapid increase of the killing effect of the malaria gametocyte in areas with a high rate of carrying.

Asymptomatic parasitaemia infections bring new challenges for malaria control in Comoros.

AbstractBackground

. Malaria has rebounded significantly in 2018 in the Comoros. It posed an urgent need to conduct clinical trials to investigate the effectiveness of artemisinin and its derivatives there.

Methods

. From June 2019 and January 2020, an open-label, non-randomized controlled trial of artemisinin-piperaquine (AP) and artemether-lumefantrine (AL) were conducted in Grande Comore Island. 238 uncomplicated falciparum malaria cases were enrolled and divided 1:1 into two treatments. The primary endpoint was the 42-day adequate clinical and parasitological responses (ACPR). Parasitemia and fever clearance at day 3, gametocyte, and tolerability were secondary endpoints.

Results

. The 42-day ACPR before and after PCR-corrected were 91.43% [95% confidence interval (CI): 83.93%-95.76%] and 98.06% [95%CI: 92.48%-99.66%] for AP treatment, respectively, and 96.00% [95%CI: 88.17%-98.14%] and 98.97% [95%CI: 93.58%-99.95%] for AL treatment, respectively. Complete clearance of the parasitemia as well as of fever for both groups was detected on day 3. Gametocytes disappeared on day 21 in the AP group and on day 2 in AL group, respectively. Specifically, the adverse reactions were mild in both groups.

Conclusions

: We discovered that AP and AL maintained their high efficacy and tolerance in the Comoros. Nonetheless, asymptomatic malaria infections bring new challenges to malaria control.

Keywords

artemisinin and its derivatives

artemisinin-piperaquine

artemether-lumefantrine

the Comoros

falciparum malaria

© 2022 The Author(s). Published by Elsevier Ltd.

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