Abstract
BackgroundArtemisinin-based combination therapy (ACT) was deployed in 2005 as an alternative to chloroquine and is considered the most efficacious treatment currently available for uncomplicated falciparum malaria. While widespread artemisinin resistance has not been reported to date in Africa, recent studies have reported partial resistance in Rwanda. The purpose of this study is to provide a current systematic review and meta-analysis on ACT at Mali study sites, where falciparum malaria is highly endemic.MethodsA systematic review of the literature maintained in the bibliographic databases accessible through the PubMed, ScienceDirect and Web of Science search engines was performed to identify research studies on ACT occurring at Mali study sites. Selected studies included trials occurring at Mali study sites with reported polymerase chain reaction (PCR)-corrected adequate clinical and parasite response rates (ACPRcs) at 28 days. Data were stratified by treatment arm (artemether–lumefantrine (AL), the first-line treatment for falciparum malaria in Mali and non-AL arms) and analysed using random-effects, meta-analysis approaches.ResultsA total of 11 studies met the inclusion criteria, and a risk of bias assessment carried out by two independent reviewers determined low risk of bias among all assessed criteria. The ACPRc for the first-line AL at Mali sites was 99.0% (95% CI (98.3%, 99.8%)), while the ACPRc among non-AL treatment arms was 98.9% (95% CI (98.3%, 99.5%)). The difference in ACPRcs between non-AL treatment arms and AL treatment arms was not statistically significant (p = .752), suggesting that there are potential treatment alternatives beyond the first-line of AL in Mali.ConclusionsACT remains highly efficacious in treating uncomplicated falciparum malaria in Mali. Country-specific meta-analyses on ACT are needed on an ongoing basis for monitoring and evaluating drug efficacy patterns to guide local malaria treatment policies, particularly in the wake of observed artemisinin resistance in Southeast Asia and partial resistance in Rwanda.
Highlights
Artemisinin-based combination therapy (ACT) was deployed in 2005 as an alternative to chloroquine and is considered the most efficacious treatment currently available for uncomplicated falciparum malaria
32 were excluded for the following reasons: protocol studies; replicate results from other selected studies; ACT was studied as a preventive treatment therapy, the study did not include an ACT arm or did not include reported ACPRcs (20 studies); study did not include Mali study sites; and, Mali sites could not be de-aggregated from multicountry studies or included replicate results from previously selected studies
ACT remains highly efficacious in treating uncomplicated falciparum malaria in Mali
Summary
Artemisinin-based combination therapy (ACT) was deployed in 2005 as an alternative to chloroquine and is considered the most efficacious treatment currently available for uncomplicated falciparum malaria. Chloroquine was the firstline treatment of uncomplicated falciparum malaria, and molecular markers for its resistance were first observed in 2001 [3]. Artemisinin-based combination therapy (ACT) has since replaced chloroquine due to widespread resistance [4, 5]. ACT is currently used in Africa, Asia and South America [7] and is recommended as first-line treatment of uncomplicated falciparum malaria [8]. ACT is deployed as a combination therapy as the use of artemisinin monotherapy has been shown to promote the development of artemisinin resistance [10]. While ACT is intended for malaria treatment, it has been efficacious in preventing transmission [13]
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