Artemisinin-based combination therapy for treating uncomplicated malaria

Sinclair, David; Zani, Babalwa; Donegan, Sarah; Olliaro, Piero; Garner, Paul

doi:10.1002/14651858.cd007483.pub2

Cited by 231 publications

(210 citation statements)

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“…In this way, even in areas with chloroquine resistance, the antimalarial effects of both drugs and the possibly beneficial immune-modulating effects of chloroquine could be combined. Another interesting candidate might be dihydroartemisinin-piperaquine, which is an effective first-line treatment for P. falciparum malaria in both adults and children (Four Artemisinin-Based Combinations (4ABC) Study Group, 2011;Sinclair et al, 2009). …”

Section: Innovative Application Of Drug Use In the Fieldmentioning

confidence: 99%

Enhancement of naturally acquired immunity against malaria by drug use

Bijker

Sauerwein

2012

Journal of Medical Microbiology

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Combination of chemoprophylaxis with chloroquine and so-called 'controlled human malaria infections' has been shown to induce sustained and fully protective immunity against malaria in experimental settings. This opens possibilities of translating this approach into an effective and applicable strategy for the field. We review the different ways in which antimalarial drugs have been used for prevention of malaria in endemic settings and discuss the possibilities and challenges of applying a strategy of drug use and naturally acquired infection in the field. IntroductionMalaria remains one of the most important infectious diseases worldwide, causing almost 655 000 deaths per year, of which the majority are children under 5 years of age. Intense malaria control interventions during the past decade have successfully established a reduction of more than 50 % in either confirmed cases of malaria or malaria admissions and deaths in 11 countries of the WHO African region (WHO, 2011a). However, increases in the number of malaria cases in 2009 in Rwanda, Sao Tome and Principe and Zambia, which previously reported reductions, illustrate the fragility of the current successes. This underlines the need for additional and innovative strategies.Availability of an effective vaccine would greatly contribute to malaria control and elimination. It is well known that clinical immunity is acquired in endemic areas after a number of years and a sufficient number of naturally acquired infections (Snow & Marsh, 1995). The search for malaria vaccines against Plasmodium falciparum has been pursued for decades, with the main focus on the development of subunit-vaccines, but with limited success. Twenty candidate vaccines are currently under clinical investigation but only one product, RTS,S, has progressed into a phase 3 field trial having recently shown encouraging indications of protection in an interim evaluation (RTS,S Clinical Trials Partnership, 2011; WHO, 2011b).One of the shortcomings of subunit-vaccines is the inability to appropriately address the significant antigenic diversity of target epitopes and the often-observed poor immunogenicity of the soluble parasite-derived proteins used. Against that background a whole-parasite approach may perform better. Indeed, immunization with sporozoite forms has consistently been shown to induce .90 % protection in rodents and humans in experimental set-ups (Friesen & Matuschewski, 2011;Hoffman et al., 2002).Transmission intensity varies greatly in sub-Saharan Africa where individuals can be subjected to up to 10 infectious bites per night at certain periods of the year. Here, we explore the idea that using medicines together with naturally acquired infection could result in the induction of protective immunity. We will review the different ways in which antimalarial drugs have been used for prevention of malaria in endemic areas and reflect on the possibilities and challenges of applying a strategy of drug use together with naturally acquired infection in the field (see Table 1 for an ov...

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Section: Innovative Application Of Drug Use In the Fieldmentioning

confidence: 99%

Enhancement of naturally acquired immunity against malaria by drug use

Bijker

Sauerwein

2012

Journal of Medical Microbiology

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“…A Cochrane meta-analysis of 50 studies 23 and a meta-analysis including 8 studies in Africa 24 concluded that there is enough evidence to suggest that AL more effectively increases crude ACPR rates.…”

Section: Discussionmentioning

confidence: 99%

Artesunate + amodiaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in the Colombian Pacific region: a noninferiority trial

Restrepo

Porras-Ramírez

Mendoza

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction: In Colombia, there are no published studies for the treatment of uncomplicated Plasmodium falciparum malaria comparing artemisinin combination therapies. Hence, it is intended to demonstrate the non-inferior efficacy/safety profiles of artesunate + amodiaquine versus artemetherlumefantrine treatments. Methods: A randomized, controlled, open-label, noninferiority (Δ≤5%) clinical trial was performed in adults with uncomplicated P. falciparum malaria using the 28-day World Health Organization validated design/definitions. Patients were randomized 1:1 to either oral artesunate + amodiaquine or artemether-lumefantrine. The primary efficacy endpoint: adequate clinical and parasitological response; secondary endpoints: -treatment failures defined per the World Health Organization. Safety: assessed through adverse events. Results: A total of 105 patients was included in each group: zero censored observations. Mean (95%CI -Confidence interval) adequate clinical and parasitological response rates: 100% for artesunate + amodiaquine and 99% for artemether-lumefantrine; the noninferiority criteria was met (Δ=1.7%). There was one late parasitological therapeutic failure (1%; artemether-lumefantrine group), typified by polymerase chain reaction as the MAD20 MSP1 allele. The fever clearance time (artesunate + amodiaquine group) was significantly shorter (p=0.002). Respectively, abdominal pain for artesunate + amodiaquine and artemether-lumefantrine was 1.9% and 3.8% at baseline (p=0.68) and 1% and 13.3% after treatment (p<0.001). Conclusions: Uncomplicated P. falciparum malaria treatment with artesunate + amodiaquine is noninferior to the artemetherlumefantrine standard treatment. The efficacy/safety profiles grant further studies in this and similar populations.

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“…A recent review comparing artesunate plus amodiaquone, artemeter-lumefantrine, artesunate plus sulfadoxinepyrimethamine, amodiaquone plus sulfadoxinepyrimethamine and dihydroartemisinin-piperaquine for treating uncomplicated P. falciparum infection has shown that all ACTs achieved the World Health Organization (WHO) defined threshold of efficacy [11]. ACTs were superior to amodiaquine plus sulfadoxine-pyrimethamine in East Africa.…”

Section: Artemisinin Combination Therapies (Acts)mentioning

confidence: 99%

Highlights of a Symposium, Malaria: Where are we Today, Where are we Going?

Wieten

Vugt

Leth

et al. 2011

TOIDJ

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Malaria continues to pose a major public health threat in endemic areas. However, times are changing, and many investments have been made in recent years into funding of malaria research, the development of more and improved control tools, and applying those to the field. Consequently, there is a renewed interest in going as far as considering the prospects of malaria elimination on a global scale. This goal cannot be reached without optimising and combining biotechnical, economical and social anthropological aspects. A symposium held on 25 January 2011 in Amsterdam, the Netherlands, organised by the Amsterdam Institute for Global Health and Development, the Center for Infection and Immunity Amsterdam and the Academic Medical Center of the University of Amsterdam, focused on malaria and the malERA eradication program, summarizing the state of the art in malaria control and beyond, and offering insight into the various possible ways forward. This manuscript summarizes the information presented and the ensuing discussions.

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Artemisinin-based combination therapy for treating uncomplicated malaria

Cited by 231 publications

References 93 publications

Enhancement of naturally acquired immunity against malaria by drug use

Enhancement of naturally acquired immunity against malaria by drug use

Artesunate + amodiaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in the Colombian Pacific region: a noninferiority trial

Highlights of a Symposium, Malaria: Where are we Today, Where are we Going?

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