Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: A multi-centre analysis
Malaria Journal, Volume 8, No. 1, Article 203, Year 2009
Notification
URL copied to clipboard!
Description
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. Methods. An individual patient data (IPD) analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints. Results. A total of 11,700 patients (75% under 5 years old), from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700). AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897) were included in randomized comparative trials with polymerase chain reaction (PCR) genotyping results and compared to 5,413 patients (half receiving an ACT). AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off) in 11/16 countries. In randomized comparative trials (n = 22), the crude efficacy of AS&AQ was 75.9% (95% CI 74.6-77.1) and the PCR-adjusted efficacy was 93.9% (95% CI 93.2-94.5). The risk (weighted by site) of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site), and not different from AS+SP or AL (artemether-lumefantrine). The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons). Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery. Conclusion. AS&AQ compares well to other treatments and meets the WHO efficacy criteria for use against falciparum malaria in many, but not all, the sub-Saharan African countries where it was studied. Efficacy varies between and within countries. An IPD analysis can inform general and local treatment policies. Ongoing monitoring evaluation is required. © 2009 Zwang et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Zwang, Julien
Thailand, Mae Sod
Shoklo Malaria Research Unit
Olliaro, Piero L.
Switzerland, Geneva
Organisation Mondiale de la Santé
Barennes, Hubert
Laos
Institut de la Francophonie Pour la Médecine Tropicale
Bonnet, Maryline M.B.
France, Paris
Epicentre
Brasseur, Philippe H.
Senegal, Dakar
Institut de Recherche Pour le Développement Dakar
Bukirwa, Hasifa
Uganda, Kampala
Uganda Malaria Surveillance Project
Cohuet, Sandra
France, Paris
Epicentre
D'Alessandro, Umberto
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Djimde, Abdoulaye A.
Mali, Bamako
University of Bamako Faculty of Medicine, Pharmacy and Odonto-stomatology
Karema, Corine Kakizi
Rwanda, Kigali
National Malaria Control Program
Guthmann, Jean Paul
France, Paris
Epicentre
Hamour, Sally M.A.
France, Paris
Epicentre
Ndiaye, Jean Louis Abdourahim
Senegal, Dakar
Université Cheikh Anta Diop de Dakar
Mårtensson, Andreas A.
Sweden, Stockholm
Karolinska Universitetssjukhuset
Rwagacondo, Claude Emile
Rwanda, Kigali
National Malaria Control Program
Sagara, Issaka
Mali, Bamako
University of Bamako Faculty of Medicine, Pharmacy and Odonto-stomatology
Samè-Ekobo, Albert
Cameroon, Yaounde
Centre Hospitalier et Universitaire de Yaounde
Sirima, Sodiomon Bienvenu
Burkina Faso, Ouagadougou
Ministere de la Sante Ouagadougou
van den Broek, I. V.
Switzerland, Geneva
Medecins Sans Frontieres
Yeka, Adoke
Uganda, Kampala
Uganda Malaria Surveillance Project
Taylor, Walter R.J.
Switzerland, Geneva
Organisation Mondiale de la Santé
Dorsey, Grant M.
United States, San Francisco
Ucsf School of Medicine
Randrianarivelojosia, Milijaona
Madagascar, Antananarivo
Institut Pasteur de Madagascar
Statistics
Citations: 91
Authors: 23
Affiliations: 16
Identifiers
Doi:
10.1186/1475-2875-8-203
e-ISSN:
14752875
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Rwanda