ArticleThe Journal of infectious diseases2025
Artemether-Lumefantrine Treatment Selects Plasmodium falciparum Multidrug Resistance 1 (pfmdr1) Increased Copy Number Among African Malaria Infections.
Article in The Journal of infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Plasmodium falciparum antimalarial resistance in Angola: a systematic review.Malaria journal · 2026Pooled it
- Emergence and spread of Plasmodium falciparum PX1 polymorphisms associated with decreased susceptibility to antimalarials in Uganda.Nature medicine · 2026Article
- Age-Related and Seasonal Variation in Malaria and Other Causes of Fever and Their Association With Clinical Outcomes in Southern Angola: A Hospital-Based Study.Tropical medicine & international health : TM & IH · 2026Article
- Efficacy of artemether-lumefantrine combination for the treatment of uncomplicated Plasmodium falciparum malaria after 16 years of its introduction into Ghana's antimalarial medicines policy.Malaria journal · 2026Article
- Prevalence of molecular markers related to artemisinin partial resistance and ACT partner drug resistance in the Plasmodium falciparum population in Kongo Central, DRC.Malaria journal · 2026Article
- Slowing the spread of treatment failure to artemisinin-based combination therapies in Uganda.Nature communications · 2026Article
- Hidden Infections, Emerging Resistance: Underdiagnosed Plasmodium vivax and Multidrug Resistance-1 (pvmdr1) Gene Amplification in the Guiana Shield.The Journal of infectious diseases · 2026Article
- Geographical Variation in Antimalarial Drug Resistance Marker Prevalence Across the Southern African Elimination Eight Region.medRxiv : the preprint server for health sciences · 2026Article
- AbioRxiv : the preprint server for biology · 2026Article
- Cross-border molecular epidemiology of Plasmodium falciparum drug susceptibility: insights from the Uganda-Democratic Republic of the Congo border.Malaria journal · 2026Article
- Emergence of artemisinin-based combination therapy resistance markers inAntimicrobial agents and chemotherapy · 2026Article
- Border Region Surveillance of Malaria Drug Resistance, Northern Burundi, 2023-2024.Emerging infectious diseases · 2026Article
- Molecular markers of antimalarial drug resistance in pfk13, pfmdr1, pfdhfr, and pfdhps genes of Plasmodium falciparum in a rural municipality in Cubal, Benguela Province, Angola (2022-2023).Malaria journal · 2026Article
- Geographical Heterogeneity in Antimalarial Resistance Markers Revealed by Genomic Surveillance in Angola, 2023.medRxiv : the preprint server for health sciences · 2025Article
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18 authors.
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Abstract
backgroundDecreased efficacy of artemether-lumefantrine, the globally most used antimalarial, has recently emerged in Africa.
methodsAn efficacy trial was carried out based on directly observed artemether-lumefantrine therapy at Bengo, Northern Angola. One-hundred Plasmodium falciparum uncomplicated malaria patients (2-10 years old) were enrolled, hospitalized for the treatment period, and followed up for 42 days. Polymerase chain reaction (PCR) correction was performed with pfmsp1/2 plus glurp, with analysis considering 2 or 3 coincident markers. Infections were tested by quantitative PCR (qPCR) for pfmdr1 copy number (pfmdr1×N), a potential P. falciparum marker of lumefantrine resistance previously identified in the region. In vitro clone mixtures were built and used to determine the relation between qPCR copy number scores and actual intrainfection quantitative fractions of pfmdr1×N.
resultsWe observed a significant posttreatment selection of gene amplification, suggesting a role in the parasite in vivo response to this drug. pfmdr1×2 qPCR scores of 1.3, 1.4, and 1.5 were determined to correspond to 15%, 25%, and 35% intrainfection rates. Patients carrying infections with a score ≥1.4 at baseline were linked to decreased artemether-lumefantrine day 42 efficacy (79% vs 97% single-copy pfmdr1). All infections were pfmdr1 N86 carriers and no pfk13 mutations were found.
conclusionsOur study suggests pfmdr1×N as a marker of P. falciparum in vivo response to lumefantrine in Africa, while indicating patients carrying infections with a pretreatment pfmdr1×N score ≥1.4 before treatment are a group experiencing decreased artemether-lumefantrine performance.
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