title: [Evaluation of the efficacy and safety of three 2-drug combinations for the treatment of uncomplicated Plasmodium falciparum malaria in Senegal: artesunate-amodiaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine].
abstract: BACKGROUND
  Since 2006, artemisinin-based combination therapies (ACT) have been used to treat uncomplicated Plasmodium falciparum malaria in Senegal, as recommended by WHO. Recently, decreased parasite clearance with artemisinin derivatives has been reported in Cambodia and Thailand. The effectiveness of artemisinin derivatives in Africa must be monitored. This study was conducted to evaluate the efficacy and the tolerability of three ACT widely used in Senegal.
  
  
  METHODS
  From October 2010 to February 2011, a descriptive and analytical sequential study was conducted in adults and children to evaluate these three combinations: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DHAPQ). The study took place at the health posts of Deggo and Pikine and the health center of Guédiawaye, in the suburbs of Dakar. The primary endpoint was the PCR-corrected adequate clinical and parasitological response (ACPR) at day 28 (D28); the secondary endpoints included ACPR at D42, clearance times for parasites, fever, and gametocytes, and the incidence of adverse events.
  
  
  RESULTS
  The study included 393 patients: 139 in the AL group, 130 in the ASAQ group, and 124 in the DHAPQ group. In the intent-to-treat population, PCR-corrected ACPR at day 28 was 92.8% in the AL, 89.2% in the ASAQ, and 91.1% in the DHAPQ (p = 0.58) groups, and in the per-protocol population, 98.4%, 98.3%, and 100% respectively (p = 0.39). At D42, ACPR was 99.2% in the AL, and 99.1% in each of the ASAQ and DHAPQ arms (p = 1). No early therapeutic failure (ETF) was observed. The combinations were well tolerated, with no serious adverse events reported during the follow-up period.
  
  
  CONCLUSIONS
  These combinations are still effective and well-tolerated. Continued monitoring is nonetheless essential to detect early artemisinin resistance in Africa.
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: D
authors.initials: D
authors.lastname: Sow
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: J-L
authors.initials: JL
authors.lastname: Ndiaye
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: K
authors.initials: K
authors.lastname: Sylla
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: M S
authors.initials: MS
authors.lastname: Ba
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: R C K
authors.initials: RC
authors.lastname: Tine
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: B
authors.initials: B
authors.lastname: Faye
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: M
authors.initials: M
authors.lastname: Pene
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: M
authors.initials: M
authors.lastname: Ndiaye
authors.affiliation: Worldwide Antimalarial Resistance Network (WWARN), Sénégal.
authors.forename: A
authors.initials: A
authors.lastname: Seck
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: A C
authors.initials: AC
authors.lastname: Lo
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: A
authors.initials: A
authors.lastname: Abiola
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: Y
authors.initials: Y
authors.lastname: Dieng
authors.affiliation: Service de parasitologie, faculté de médecine, université Cheikh Anta Diop, Fann, 5005 Dakar, Sénégal.
authors.forename: O
authors.initials: O
authors.lastname: Gaye
mesh_terms: D000293:Adolescent; D000328:Adult; D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011804:Quinolines / Q000627:therapeutic use*; D012675:Senegal; D016896:Treatment Outcome; D055815:Young Adult; D010879:Piperazines
chemical_list: D000655:Amodiaquine; D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011804:Quinolines; C515299:amodiaquine, artesunate drug combination; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
keywords: Plasmodium falciparum; Senegal; artemether-lumefantrine; artesunate-amodiaquine; dihydroartemisinin-piperaquine; efficacy; uncomplicated malaria