Abstract
BackgroundDihydroartemisinin-piperaquine (DHA-PQ) is one of five WHO recommended artemisinin combination therapy (ACT) for the treatment of uncomplicated malaria. However, little was known on its post-registration safety and effectiveness in sub-Saharan Africa. DHA-PQ provides a long post-treatment prophylactic effect against re-infection; however, new infections have been reported within a few weeks of treatment, especially in children. This paper reports the clinical outcomes following administration of DHQ-PQ in real-life conditions in public health facilities in Burkina Faso, Ghana, Mozambique, and Tanzania for the treatment of confirmed uncomplicated malaria.MethodsAn observational, non-comparative, longitudinal study was conducted on 10,591 patients with confirmed uncomplicated malaria visiting public health facilities within seven health and demographic surveillance system sites in four African countries (Ghana, Tanzania, Burkina Faso, Mozambique) between September 2013 and April 2014. Patients were treated with DHA-PQ based on body weight and followed up for 28 days to assess the clinical outcome. A nested cohort of 1002 was intensely followed up. Clinical outcome was assessed using the proportion of patients who reported signs and symptoms of malaria after completing 3 days of treatment.ResultsA total of 11,097 patients were screened with 11,017 enrolled, 94 were lost to follow-up, 332 withdrew and 10,591 (96.1 %) patients aged 6 months–85 years met protocol requirements for analysis. Females were 52.8 and 48.5 % were <5 years of age. Malaria was diagnosed by microscopy and rapid diagnostic test in 69.8 % and 29.9 %, respectively. At day 28, the unadjusted risk of recurrent symptomatic parasitaemia was 0.5 % (51/10,591). Most of the recurrent symptomatic malaria patients (76 %) were children <5 years. The mean haemoglobin level decreased from 10.6 g/dl on day 1 to 10.2 g/dl on day 7. There was no significant renal impairment in the nested cohort during the first 7 days of follow-up with minimal non-clinically significant changes noted in the liver enzymes.ConclusionDHA-PQ was effective and well tolerated in the treatment of uncomplicated malaria and provides an excellent alternative first-line ACT in sub-Saharan Africa.
Highlights
Dihydroartemisinin-piperaquine (DHA-PQ) is one of five World Health Organization (WHO) recommended artemisinin combination therapy (ACT) for the treatment of uncomplicated malaria
Artemisinin-based combination therapy (ACT) is highly effective for the treatment of uncomplicated falciparum malaria with five formulations, including dihydroartemisinin (DHA) and piperaquine (PQ) combination currently recommended by the World Health Organization (WHO) [1]
These partner drugs (e.g., PQ, mefloquine, amodiaquine, lumefantrine, pyronaridine) are eliminated slowly compared to the artemisinin derivatives (e.g., DHA, artesunate, artemether), which are eliminated rapidly, they swiftly bring down the parasite biomass [3]
Summary
Dihydroartemisinin-piperaquine (DHA-PQ) is one of five WHO recommended artemisinin combination therapy (ACT) for the treatment of uncomplicated malaria. Artemisinin-based combination therapy (ACT) is highly effective for the treatment of uncomplicated falciparum malaria with five formulations, including dihydroartemisinin (DHA) and piperaquine (PQ) combination currently recommended by the World Health Organization (WHO) [1]. The different modes of action of the partner drugs contribute to the efficacy of ACT These partner drugs (e.g., PQ, mefloquine, amodiaquine, lumefantrine, pyronaridine) are eliminated slowly compared to the artemisinin derivatives (e.g., DHA, artesunate, artemether), which are eliminated rapidly, they swiftly bring down the parasite biomass [3]. The half-life of PQ is 21–28 days [5–7], longer than most of the partner drugs used in ACT, providing a longer post-treatment prophylactic effect compared to lumefantrine (3–5 days) [3, 8], the active amodiaquine metabolite desethylamodiaquine (7–12 days) [9], mefloquine (17–24 days) [10], and pyronaridine (13.2 and 9.6 days in adults and children, respectively) [11]. Pooled analysis of seven randomized, controlled trials on ACT, including Dihydroartemisinin-piperaquine (DHA-PQ) from 14 sub-Saharan African sites of 3044 children ≤5 years showed a decline in Hb levels on day 7 with recovery between days 14–28 [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
