title: Therapeutic efficacy trial of artemisinin-based combination therapy for the treatment of uncomplicated malaria and investigation of mutations in k13 propeller domain in Togo, 2012-2013.
abstract: Since 2005, the Togo National Malaria Control Programme has recommended two different formulations of artemisinin-based combination therapy (ACT), artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL), for the treatment of uncomplicated malaria. Regular efficacy monitoring of these two combinations is conducted every 2 or 3 years. This paper reports the latest efficacy assessment results and the investigation of mutations in the k13 propeller domain.
  
  
  
  The study was conducted in 2012-2013 on three sentinel sites of Togo (Lomé, Sokodé and Niamtougou). Children aged 6-59 months, who were symptomatically infected with Plasmodium falciparum, were treated with either AL (Coartem(®), Novartis Pharma, Switzerland) or ASAQ (Co-Arsucam(®), Sanofi Aventis, France). The WHO standard protocol for anti-malarial treatment evaluation was used. The primary end-point was 28-day adequate clinical and parasitological response (ACPR), corrected to exclude reinfection using polymerase-chain reaction (PCR) genotyping.
  
  
  
  A total of 523 children were included in the study. PCR-corrected ACPR was 96.3-100 % for ASAQ and 97-100 % for AL across the three study sites. Adverse events were negligible: 0-4.8 % across all sites, for both artemisinin-based combinations. Upon investigation of mutations in the k13 propeller domain, only 9 (1.8 %) mutations were reported, three in each site. All mutant parasites were cleared before day 3. All day 3 positive patients were infected with k13 wild type parasites.
  
  
  
  The efficacy of AL and ASAQ remains high in Togo, and both drugs are well tolerated. ASAQ and AL would be recommended for the treatment of uncomplicated malaria in Togo.
authors.affiliation: Faculté des Sciences de la Sante, Université de Lomé, BP 1515, Lomé, Togo. monicadork@yahoo.fr.|Ministere de la Sante et de la Protection Sociale, Angle avenue Sarakawa et avenue du 2 Fevrier, BP 336, Lomé, Togo. monicadork@yahoo.fr.
authors.forename: Améyo M
authors.initials: AM
authors.lastname: Dorkenoo
authors.affiliation: Ministere de la Sante et de la Protection Sociale, Angle avenue Sarakawa et avenue du 2 Fevrier, BP 336, Lomé, Togo.
authors.forename: Degninou
authors.initials: D
authors.lastname: Yehadji
authors.affiliation: Faculté des Sciences de la Sante, Université de Lomé, BP 1515, Lomé, Togo.
authors.forename: Yao M
authors.initials: YM
authors.lastname: Agbo
authors.affiliation: Ministere de la Sante et de la Protection Sociale, Angle avenue Sarakawa et avenue du 2 Fevrier, BP 336, Lomé, Togo.
authors.forename: Yao
authors.initials: Y
authors.lastname: Layibo
authors.affiliation: Service de Pediatrie, Centre Hospitalier Regional de Sokode, BP 187, Lomé, Togo.
authors.forename: Foli
authors.initials: F
authors.lastname: Agbeko
authors.affiliation: Programme National de Lutte contre le Paludisme, Quartier Administratif, BP 518, Lomé, Togo.
authors.forename: Poukpessi
authors.initials: P
authors.lastname: Adjeloh
authors.affiliation: Programme National de Lutte contre le Paludisme, Quartier Administratif, BP 518, Lomé, Togo.
authors.forename: Kossi
authors.initials: K
authors.lastname: Yakpa
authors.affiliation: Service des Laboratoires, Centre Hospitalier Universitaire Sylvanus Olympio, 198 rue de l'Hopital, Tokoin Hopital, BP 57, Lomé, Togo.
authors.forename: Efoe
authors.initials: E
authors.lastname: Sossou
authors.affiliation: Programme National de Lutte contre le Paludisme, Quartier Administratif, BP 518, Lomé, Togo.
authors.forename: Fantchè
authors.initials: F
authors.lastname: Awokou
authors.affiliation: Global Malaria Programme, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Ringwald
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000235:genetics; D004338:Drug Combinations; D004351:Drug Resistance; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D060005:Genotyping Techniques; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D009154:Mutation; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D015800:Protozoan Proteins / Q000235:genetics*; D014037:Togo; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D016054:DNA, Protozoan; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D015800:Protozoan Proteins; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine
keywords: Artemisinin; Artemisinin combination therapy; Efficacy; Malaria; Togo; Treatment failure; k13