title: Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial.
abstract: OBJECTIVE
  To compare the efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) for treating uncomplicated falciparum malaria in Uganda.
  
  
  METHODS
  Randomized single-blinded clinical trial.
  
  
  METHODS
  Apac, Uganda, an area of very high malaria transmission intensity.
  
  
  METHODS
  Children aged 6 mo to 10 y with uncomplicated falciparum malaria.
  
  
  METHODS
  Treatment of malaria with AL or DP, each following standard 3-d dosing regimens.
  
  
  METHODS
  Risks of recurrent parasitemia at 28 and 42 d, unadjusted and adjusted by genotyping to distinguish recrudescences and new infections.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Makerere University, Kampala, Uganda. mkamya@infocom.co.ug
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.forename: Adoke
authors.initials: A
authors.lastname: Yeka
authors.forename: Hasifa
authors.initials: H
authors.lastname: Bukirwa
authors.forename: Myers
authors.initials: M
authors.lastname: Lugemwa
authors.forename: John B
authors.initials: JB
authors.lastname: Rwakimari
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Staedke
authors.forename: Ambrose O
authors.initials: AO
authors.lastname: Talisuna
authors.forename: Bryan
authors.initials: B
authors.lastname: Greenhouse
authors.forename: François
authors.initials: F
authors.lastname: Nosten
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenthal
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey