Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treatment of Malaria: A Randomized Trial

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dc.contributor.authorKamya, Moses R.
dc.contributor.authorYeka, Adoke
dc.contributor.authorBukirwa, Hasifa
dc.contributor.authorLugemwa, Myers
dc.contributor.authorRwakimari, John B.
dc.contributor.authorStaedke, Sarah G.
dc.contributor.authorTalisuna, Ambrose O.
dc.contributor.authorMangen, Fred Wabwire
dc.date.accessioned2022-04-09T17:12:57Z
dc.date.available2022-04-09T17:12:57Z
dc.date.issued2007
dc.description.abstractTo compare the efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) for treating uncomplicated falciparum malaria in Uganda.Randomized single-blinded clinical trial.Apac, Uganda, an area of very high malaria transmission intensity.Children aged 6 mo to 10 y with uncomplicated falciparum malaria.Treatment of malaria with AL or DP, each following standard 3-d dosing regimens.Risks of recurrent parasitemia at 28 and 42 d, unadjusted and adjusted by genotyping to distinguish recrudescences and new infections.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.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.en_US
dc.identifier.citationKamya, M. R., Yeka, A., Bukirwa, H., Lugemwa, M., Rwakimari, J. B., Staedke, S. G., ... & Dorsey, G. (2007). Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial. PLoS clinical trials, 2(5), e20.https://doi.org/10.1371/journal.pctr.0020020en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/2898
dc.language.isoenen_US
dc.publisherPLoS clinical trialsen_US
dc.subjectACT, artemisinin-based combination therapy; AL, artemetherlumefantrine; AQ, amodiaquine; AS, artesunate; CI, confidence interval; CQ, chloroquine; DP, dihydroartemisininpiperaquine; ETF, early treatment failure; HBMF, home-based management of fever; ITN, insecticide-treated bed net; LCF, late clinical failure; LPF, late parasitological failure; RD, risk difference; SD, standard deviation; SP, sulfadoxinepyrimethamine; WBC, white blood cell; WHO, World Health Organizationen_US
dc.titleArtemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treatment of Malaria: A Randomized Trialen_US
dc.typeArticleen_US
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