title: The emerging threat of artemisinin resistance in malaria: focus on artemether-lumefantrine.
abstract: The development of artemisinin resistance in the Greater Mekong Subregion poses a significant threat to malaria elimination. Artemisinin-based combination therapies including artemether-lumefantrine (AL) are recommended by WHO as first-line treatment for uncomplicated Plasmodium falciparum malaria. This article provides a comprehensive review of the existing and latest data as a basis for interpretation of observed variability in parasite sensitivity to AL over the last 5 years. Clinical efficacy and preclinical data from a range of endemic countries are summarized, including potential molecular markers of resistance. Overall, AL remains effective in the treatment of uncomplicated P. falciparum malaria in most regions. Establishing validated molecular markers for resistance and strict efficacy monitoring will reinforce timely updates of treatment policies.
authors.affiliation: Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Bamako, Mali.
authors.forename: Abdoulaye A
authors.initials: AA
authors.lastname: Djimde
authors.forename: Michael
authors.initials: M
authors.lastname: Makanga
authors.forename: Kelli
authors.initials: K
authors.lastname: Kuhen
authors.forename: Kamal
authors.initials: K
authors.lastname: Hamed
mesh_terms: D017954:Africa South of the Sahara; D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000494:pharmacology / Q000627:therapeutic use; D001208:Asia; D004338:Drug Combinations; D004351:Drug Resistance / Q000235:genetics; D004983:Ethanolamines / Q000494:pharmacology / Q000627:therapeutic use; D005449:Fluorenes / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000235:genetics; D010963:Plasmodium falciparum / Q000187:drug effects*
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C031327:artemisinin; D000077549:Artemether; D000078102:Lumefantrine
keywords: artemether-lumefantrine; artemisinin resistance; clinical efficacy; molecular markers; systematic review