Evidence map›Paper›PMID 29615039›Full record

ArticleMalaria journal2018

Efficacy and safety of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in three provinces in Angola, 2017.

Elizabeth Davlantes, Pedro Rafael Dimbu, Carolina Miguel Ferreira, Maria Florinda Joao, Dilunvuidi Pode, Jacinto Félix, Edgar Sanhangala, Benjamin Nieto Andrade, Samaly Dos Santos Souza, Eldin Talundzic and 8 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Malaria journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
52citing papers in PubMed, 7 pooled it
14.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

52 citing papers in PubMed, 7 syntheses or guidelines pooled it, 98 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 6 institutions in 3 countries.

Elizabeth DavlantesEpidemic Intelligence Service, United States Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA. Lyo2@cdc.gov.
Pedro Rafael DimbuNational Malaria Control Programme, Ministry of Health, Luanda, Angola.
Carolina Miguel FerreiraPSI Angola, Luanda, Angola.
Maria Florinda JoaoNational Malaria Control Programme, Ministry of Health, Luanda, Angola.
Dilunvuidi PodeField Epidemiology Training Programme, Ministry of Health, Luanda, Angola.
Jacinto FélixField Epidemiology Training Programme, Ministry of Health, Luanda, Angola.
Edgar SanhangalaField Epidemiology Training Programme, Ministry of Health, Luanda, Angola.
Benjamin Nieto AndradePSI Angola, Luanda, Angola.
Samaly Dos Santos SouzaMalaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Eldin TalundzicMalaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Venkatachalam UdhayakumarMalaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Chantelle OwensMalaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Eliane MboungaUnited States President's Malaria Initiative, United States Agency for International Development, Luanda, Angola.
Lubbe WiesnerDivision of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.
Eric S HalseyMalaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
José Franco MartinsNational Malaria Control Programme, Ministry of Health, Luanda, Angola.
Filomeno FortesNational Malaria Control Programme, Ministry of Health, Luanda, Angola.
Mateusz M PlucinskiMalaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ministry of Health · AOU.S. President's Malaria Initiative · USCenters for Disease Control and Prevention · USClínica Sagrada Esperança · AOEpidemic Intelligence Service · USUniversity of Cape Town · ZA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Angolan government recommends three artemisinin-based combinations for the treatment of uncomplicated Plasmodium falciparum malaria: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DP). Due to the threat of emerging anti-malarial drug resistance, it is important to periodically monitor the efficacy of artemisinin-based combination therapy (ACT). This study evaluated these medications' therapeutic efficacy in Benguela, Lunda Sul, and Zaire Provinces.

methodsEnrollment occurred between March and July 2017. Study participants were children with P. falciparum monoinfection from each provincial capital. Participants received a 3-day course of a quality-assured artemisinin-based combination and were monitored for 28 (AL and ASAQ arms) or 42 days (DP arm). Each ACT was assessed in two provinces. The primary study endpoints were: (1) follow-up without complications and (2) failure to respond to treatment or development of recurrent P. falciparum infection. Parasites from each patient experiencing recurrent infection were genotyped to differentiate new infection from recrudescence of persistent parasitaemia. These parasites were also analysed for molecular markers associated with ACT resistance.

resultsOf 608 children enrolled in the study, 540 (89%) reached a primary study endpoint. Parasitaemia was cleared within 3 days of medication administration in all participants, and no early treatment failures were observed. After exclusion of reinfections, the corrected efficacy of AL was 96% (91-100%, 95% confidence interval) in Zaire and 97% (93-100%) in Lunda Sul. The corrected efficacy of ASAQ was 100% (97-100%) in Benguela and 93% (88-99%) in Zaire. The corrected efficacy of DP was 100% (96-100%) in Benguela and 100% in Lunda Sul. No mutations associated with artemisinin resistance were identified in the pfk13 gene in the 38 cases of recurrent P. falciparum infection. All 33 treatment failures in the AL and ASAQ arms carried pfmdr1 or pfcrt mutations associated with lumefantrine and amodiaquine resistance, respectively, on day of failure.

conclusionsAL, ASAQ, and DP continue to be efficacious against P. falciparum malaria in these provinces of Angola. Rapid parasite clearance and the absence of genetic evidence of artemisinin resistance are consistent with full susceptibility to artemisinin derivatives. Periodic monitoring of in vivo drug efficacy remains a priority routine activity for Angola.

Indexed as

AdolescentAmodiaquineAngolaAntimalarialsArtemether, Lumefantrine Drug CombinationArtemisininsChildChild, PreschoolDrug CombinationsFemaleHumansInfantMalaria, FalciparumMaleParasitemiaPiperazinesAmodiaquineamodiaquine, artesunate drug combinationAntimalarialsArtemether, Lumefantrine Drug CombinationArtemisininsartenimolDrug CombinationspiperaquinePiperazinesQuinolinesAntimalarial resistanceArtemether–lumefantrineArtesunate–amodiaquineDihydroartemisinin–piperaquinepfcrtpfK13pfmdr1pfpm2

Identifiers

PMID29615039
PMCPMC5883595
OpenAlexW2802043998

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.