title: In Vivo Efficacy and Parasite Clearance of Artesunate + Sulfadoxine-Pyrimethamine Versus Artemether-Lumefantrine in Mali.
abstract: Although artemisinin resistance has yet to be reported in Africa, surveillance of the efficacy of artemisinin-based combination therapies (ACTs) is warranted. Here, the efficacy of artesunate + sulfadoxine-pyrimethamine (AS + SP) and artemether-lumefantrine (AL) was evaluated in Mali. Randomized open-label comparative in vivo assay of AS + SP versus AL were carried out using the 28-day follow-up World Health Organization protocol. Patients with uncomplicated falciparum malaria and at least 6 months of age were recruited between October 2010 and January 2014. A subset of these patients was selected to measure Plasmodium falciparum clearance time. Polymerase chain reaction-corrected adequate clinical and parasitological responses were 100% for AS + SP and 98.2% for AL with no significant difference (P = 0.06). The reinfection rates were comparable (P = 0.63) with 8.0% for AS + SP and 12.6% for AL. Individuals under 8 years were more susceptible to treatment failure (relative risk = 1.9; 95% confidence interval = 1.2, 3.3). Median parasite clearance half-life was 1.7 hours (interquartile range [IQR] = 1.3-2.2) for AS + SP and 1.9 hours (IQR = 1.5-2.5) for AL with no statistically significant difference (P = 0.24). Efficacy of AS + SP and AL was high. This study provides baseline information on parasite clearance half-lives after ACT treatment, particularly AS + SP, in Mali.
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland karaniare@icermali.org okd@icermali.org.
authors.forename: Karamoko
authors.initials: K
authors.lastname: Niaré
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Dara
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Issaka
authors.initials: I
authors.lastname: Sagara
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Mahamadou S
authors.initials: MS
authors.lastname: Sissoko
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Cheick Oumar
authors.initials: CO
authors.lastname: Guindo
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Nana H
authors.initials: NH
authors.lastname: Cissé
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Cheick Oumar
authors.initials: CO
authors.lastname: Coulibaly
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Ringwald
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Françoise
authors.initials: F
authors.lastname: Benoit-Vical
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Berry
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Abdoulaye A
authors.initials: AA
authors.lastname: Djimdé
authors.affiliation: Département d'Epidémiologie des Affections Parasitaires (DEAP), Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali; World Health Organization Office, Bamako, Mali; Drug Resistance and Containment, Global Malaria Programme, World Health Organization, Geneva, Switzerland; Laboratoire de Chimie de Coordination (LCC), Centre National de la Recherche Scientifique, Toulouse, France; Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France; Centre de Physiopathologie de Toulouse Purpan (CPTP), Université de Toulouse, Toulouse, France; Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland karaniare@icermali.org okd@icermali.org.
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; 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* / Q000453:epidemiology; D008297:Male; D008302:Mali / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects*; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C578917:sulfadoxine-pyrimethamine-artesunate; D000077332:Artesunate; D013413:Sulfadoxine; D011739:Pyrimethamine
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