Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: a multi-centre analysis

Abstract

Background: Artesunate and amodiaquine (AS&AQ) is at present the world's second most widely used artemisinin-based combination therapy (ACT). It was necessary to evaluate the efficacy of ACT, recently adopted by the World Health Organization (WHO) and deployed over 80 countries, in order to make an evidence-based drug policy.

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

“…This significant fever clearance difference for the comparison of AS+AQ and AL have also been reported by Koram et al (p=0.006) 32 . In this report, the proportion of patients treated with AS+AQ that remained febrile at Day 2 was significantly lower when compared to those treated with AL, similar to a finding previously reported in another larger study (2.8% versus 6.3%, respectively; p=0.001) 14 . Even though the clinical relevance of small but significant differences in fever clearance times is arguable, it seems evident that ACT in general 26 , and AS+AQ in particular, offer a faster relief from the febrile state and the associated inflammatory response.…”

“…The correlation between parasitemia and fever clearance times has been verified in other reports 14,33 . The study by Zwang et al found that parasitemia and fever percentages of patients treated with AS+AQ were, respectively, 66.4% and 7.4% on day 1; 8.5% and 2.4% on day 2; 1.8% and 2.4% on day 3; and 0.6% on day 7.…”

“…In the analysis performed by Zwang et al, the comparison of AS+AQ with AL yielded differences in the crude failure risks. The adjusted hazard ratio (95% CI) for AL was 0.79 (0.57-1.10), yielding a nonsignificant PCR-adjusted failure risk 14 . Neither LCTF nor LPTF were observed in the AS+AQ group, yielding a 0% failure rate.…”

“…On the other hand, Zwang et al demonstrated that PCR adjustment yields inconsistent ACPR rate results 14 . These authors performed an analysis of 26 studies (n=5,942) comparing AS+AQ to other ACT in a pooled sub-Saharan African population.…”

“…Treatment with AS+AQ has been used in Africa for the treatment of P. falciparum malaria with very good efficacy, safety, and costeffectiveness profiles 14,15 . This combination has been previously studied in Colombia 16 , but to date, no reports comparing its efficacy with other ACT have been published for this country.…”