ArticleMalaria journal2016
Parasite clearance rates in Upper Myanmar indicate a distinctive artemisinin resistance phenotype: a therapeutic efficacy study.
Article in Malaria journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
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Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Pooled it
- Risk of sudden unexplained death after use of dihydroartemisinin-piperaquine for malaria: a systematic review and Bayesian meta-analysis.The Lancet. Infectious diseases · 2018Pooled it
- Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria: a cluster-randomised trial.The Lancet. Infectious diseases · 2021Trial
- Trial
- Effectiveness and safety of 3 and 5 day courses of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in an area of emerging artemisinin resistance in Myanmar.Malaria journal · 2018Trial
- Efficacy of Artemether-Lumefantrine for UncomplicatedThe American journal of tropical medicine and hygiene · 2018Trial
- Experimental evolution and functional genetics identify KIC1 as a determinant of reduced artemisinin susceptibility in BangladeshibioRxiv : the preprint server for biology · 2026Article
- Functional assessment of prevalentmBio · 2026Article
- NovelmBio · 2026Article
- Advancing artemisinin resistance monitoring using a high sensitivity ddPCR assay for Pfkelch13 mutation detection in Asia.Scientific reports · 2025Article
- Artemisinin-resistant malaria.Clinical microbiology reviews · 2024Review
- Structural Modelling Prediction of RecombinantPathogens (Basel, Switzerland) · 2022Article
- Molecular Profiles of Multiple Antimalarial Drug Resistance Markers inMicroorganisms · 2022Article
- Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion: an observational study.The Lancet. Infectious diseases · 2020Observational
- Plasmodium berghei K13 Mutations MediatemBio · 2020Article
- Efficacy of Artemether-Lumefantrine on variousParasite epidemiology and control · 2020Article
- Efficacy of artemether-lumefantrine for treating uncomplicated Plasmodium falciparum cases and molecular surveillance of drug resistance genes in Western Myanmar.Malaria journal · 2020Article
- In Vitro Antimalarial and Toxicological Activities ofThe Malaysian journal of medical sciences : MJMS · 2020Article
- Evaluation of residual submicroscopic Plasmodium falciparum parasites 3 days after initiation of treatment with artemisinin-based combination therapy.Malaria journal · 2020Review
- Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine Retain High Efficacy for Treatment of UncomplicatedThe American journal of tropical medicine and hygiene · 2020Article
Corrections and comments
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Authors and funding
15 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundArtemisinin resistance in Plasmodium falciparum extends across Southeast Asia where it is associated with worsening partner drug resistance and a decline in the efficacy of frontline artemisinin-based combination therapy. Dihydroartemisinin-piperaquine (DP) is an essential component of preventive and curative treatment in the region, but its therapeutic efficacy has fallen in Cambodia.
methodsA prospective clinical and parasitological evaluation of DP was conducted at two sites in Upper Myanmar between August 2013 and December 2014, enrolling 116 patients with acute uncomplicated falciparum malaria. Patients received DP orally for 3 days together with primaquine 0.25 mg/kg on admission. Parasite clearance half-lives based on 6 hourly blood smears, and day 42 therapeutic responses were assessed as well as parasite K13 genotypes.
resultsMedian parasite clearance half-life was prolonged, and clearance half-life was greater than 5 h in 21% of patients. Delayed parasite clearance was significantly associated with mutations in the propeller region of the parasite k13 gene. The k13 F446I mutation was found in 25.4% of infections and was associated with a median clearance half-life of 4.7 h compared with 2.7 h for infections without k13 mutations (p < 0.001). There were no failures after 42 days of follow-up, although 18% of patients had persistent parasitaemia on day 3.
conclusionThe dominant k13 mutation observed in Upper Myanmar, F446I, appears to be associated with an intermediate rate of parasite clearance compared to other common mutations described elsewhere in the Greater Mekong Subregion. Discerning this phenotype requires relatively detailed clearance measurements, highlighting the importance of methodology in assessing artemisinin resistance.
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