Sustained High Cure Rate of Artemether–Lumefantrine against Uncomplicated Plasmodium falciparum Malaria after 8 Years of Its Wide-Scale Use in Bagamoyo District, Tanzania
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Date
2017
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Publisher
The American Journal of Tropical Medicine and Hygiene
Abstract
Abstract. We assessed the temporal trend of artemether–lumefantrine (AL) cure rate after 8 years of its wide-scale use
for treatment of uncomplicated Plasmodium falciparum malaria from 2006 to 2014 in Bagamoyo district, Tanzania. Trend
analysis was performed for four studies conducted in 2006, 2007–2008, 2012–2013, and 2014. Patients with acute
uncomplicated P. falciparum malaria were enrolled, treated with standard AL regimen and followed-up for 3 (2006), 28
(2014), 42 (2012–2013), or 56 (2007–2008) days for clinical and laboratory evaluation. Primary outcome was day 28
polymerase chain reaction (PCR)-adjusted cure rate across years from 2007 to 2014. Parasite clearance was slower for
the 2006 and 2007–2008 cohorts with less than 50% of patients cleared of parasitemia on day 1, but was rapid for the
2012–2013 and 2014 cohorts. Day 28 PCR-adjusted cure rate was 168/170 (98.8%) (95% confidence interval [CI],
97.2–100), 122/127 (96.1%) (95% CI, 92.6–99.5), and 206/207 (99.5%) (95% CI, 98.6–100) in 2007–2008, 2012–2013, and
2014, respectively. There was no significant change in the trend of cure rate between 2007 and 2014 (χ2
trend test = 0.06,
P = 0.90). Pretreatment P. falciparum multidrug-resistant gene 1 (Pfmdr1) N86 prevalence increased significantly across
years from 13/48 (27.1%) in 2006 to 183/213 (85.9%) in 2014 (P < 0.001), and P. falciparum chloroquine resistance
transporter gene (Pfcrt) K76 prevalence increased significantly from 24/47 (51.1%) in 2006 to 198/205 (96.6%) in 2014 (P<
0.001). The AL cure rate remained high after 8 years of its wide-scale use in Bagamoyo district for the treatment of
uncomplicated P. falciparum malaria despite an increase in prevalence of pretreatment Pfmdr1 N86 and Pfcrt K76
between 2006 and 2014.
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Keywords
Artemether–Lumefantrine, Plasmodium falciparum, Bagamoyo District, Tanzania
Citation
Mwaiswelo, R., Ngasala, B., Gil, J.P., Malmberg, M., Jovel, I., Xu, W., Premji, Z., Mmbando, B.P., Björkman, A. and Mårtensson, A., 2017. Sustained high cure rate of artemether–lumefantrine against uncomplicated Plasmodium falciparum malaria after 8 years of its wide-scale use in Bagamoyo District, Tanzania. The American Journal of Tropical Medicine and Hygiene, 97(2), p.526.