Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data

Salim Abdulla; Ishag Adam; George O. Adjei; Martin A. Adjuik; Bereket Alemayehu; Richard Allan; Emmanuel Arinaitwe; Elizabeth A. Ashley; Mamadou S. Ba; Hubert Barennes; Karen I. Barnes; Quique Bassat; Elisabeth Baudin; Nicole Berens-Riha; Anders Bjoerkman; Francois Bompart; Maryline Bonnet; Steffen Borrmann; Teun Bousema; Philippe Brasseur; Hasifa Bukirwa; Francesco Checchi; Prabin Dahal; Umberto D'Alessandro; Meghna Desai; Alassane Dicko; Abdoulaye A. Djimde; Grant Dorsey; Ogobara K. Doumbo; Chris J. Drakeley; Stephan Duparc; Teferi Eshetu; Emmanuelle Espie; Jean-Francois Etard; Abul M. Faiz; Catherine O. Falade; Caterina I. Fanello; Jean-Francois Faucher; Babacar Faye; Oumar Faye; Scott Filler; Jennifer A. Flegg; Bakary Fofana; Carole Fogg; Nahla B. Gadalla; Oumar Gaye; Blaise Genton; Peter W. Gething; Jose P. Gil; Raquel Gonzalez; Francesco Grandesso; Bryan Greenhouse; Brian Greenwood; Anastasia Grivoyannis; Philippe J. Guerin; Jean-Paul Guthmann; Kamal Hamed; Sally Hamour; Simon I. Hay; Eva Maria Hodel; Georgina S. Humphreys; Jimee Hwang; Maman L. Ibrahim; Daddi Jima; Joel J. Jones; Vincent Jullien; Elizabeth Juma; Patrick S. Kachur; Piet A. Kager; Erasmus Kamugisha; Moses R. Kamya; Corine Karema; Kassoum Kayentao; Jean-Rene Kiechel; Fred Kironde; Poul-Erik Kofoed; Peter G. Kremsner; Sanjeev Krishna; Valerie Lameyre; Bertrand Lell; Angeles Lima; Michael Makanga; ElFatih M. Malik; Kevin Marsh; Andreas Mårtensson; Achille Massougbodji; Herve Menan; Didier Menard; Clara Menendez; Petra F. Mens; Martin Meremikwu; Clarissa Moreira; Carolyn Nabasumba; Michael Nambozi; Jean-Louis Ndiaye; Billy E. Ngasala; Frederic Nikiema; Christian Nsanzabana; Francine Ntoumi; Mary Oguike; Bernhards R. Ogutu; Piero Olliaro; Sabah A. Omar; Jean-Bosco Ouedraogo; Seth Owusu-Agyei; Louis K. Penali; Mbaye Pene; Judy Peshu; Patrice Piola; Christopher V. Plowe; Zul Premji; Ric N. Price; Milijaona Randrianarivelojosia; Lars Rombo; Cally Roper; Philip J. Rosenthal; Issaka Sagara; Albert Same-Ekobo; Patrick Sawa; Henk D. F. H. Schallig; Birgit Schramm; Amadou Seck; Seif A. Shekalaghe; Carol H. Sibley; Vronique Sinou; Sodiomon B. Sirima; Fabrice A. Som; Doudou Sow; Sarah G. Staedke; Kasia Stepniewska; Colin J. Sutherland; Todd D. Swarthout; Khadime Sylla; Ambrose O. Talisuna; Walter R. J. Taylor; Emmanuel A. Temu; Julie I. Thwing; Roger C. K. Tine; Halidou Tinto; Silva Tommasini; Offianan A. Toure; Johan Ursing; Michel T. Vaillant; Giovanni Valentini; Ingrid Van den Broek; Michele Van Vugt; Stephen A. Ward; Peter A. Winstanley; William Yavo; Adoke Yeka; Yah M. Zolia; Issaka Zongo; WWARN Artemisinin Based

doi:10.1186/s12916-015-0445-x

Back

Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data

Journal article

Peer reviewed

Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data

Salim Abdulla, Ishag Adam, George O. Adjei, Martin A. Adjuik, Bereket Alemayehu, Richard Allan, Emmanuel Arinaitwe, Elizabeth A. Ashley, Mamadou S. Ba, Hubert Barennes, …

BMC medicine, Vol.13(1), pp.212-212

07/09/2015

DOI: https://doi.org/10.1186/s12916-015-0445-x

PMCID: PMC4561425

PMID: 26343145

Abstract

Clinical Medicine

Infectious Medicine

Infektionsmedicin

Klinisk medicin

Medical and Health Sciences

Medicin och hälsovetenskap

Background: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). Methods: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. Results: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 degrees C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). Conclusions: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.

Metrics

1 Record Views

See more details

Details

Title: Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria
Creators - without role: Salim Abdulla - Ifakara Hlth Inst, Dar Es Salaam, Tanzania
Ishag Adam - University of Khartoum
George O. Adjei - University of Ghana
Martin A. Adjuik - INDEPTH Network Secretariat, Accra, Ghana
Bereket Alemayehu - Int Ctr AIDS Care & Treatment Programs, Addis Ababa, Ethiopia
Richard Allan - Mentor
Emmanuel Arinaitwe - Infect Dis Res Collaborat, Kampala, Uganda
Elizabeth A. Ashley - Epictr, Paris, France
Mamadou S. Ba - College Station Medical Center
Hubert Barennes
Karen I. Barnes
Quique Bassat
Elisabeth Baudin - Mentor
Nicole Berens-Riha
Anders Bjoerkman - Karolinska Institutet
Francois Bompart - Sanofi Aventis, Direct Acces Med Access Med, Gentilly, France
Maryline Bonnet - Epictr, Geneva, Switzerland
Steffen Borrmann
Teun Bousema
Philippe Brasseur - IRD, Dakar, Senegal
Hasifa Bukirwa - Uganda Malaria Surveillance Project, Kampala, Uganda
Francesco Checchi - Epictr, Paris, France
Prabin Dahal
Umberto D'Alessandro
Meghna Desai - Ctr Dis Control & Prevent, Div Parasit Dis & Malaria, Malaria Branch, Atlanta, GA USA
Alassane Dicko
Abdoulaye A. Djimde - University of Bamako
Grant Dorsey - College Station Medical Center
Ogobara K. Doumbo - University of Bamako
Chris J. Drakeley - German Ctr Infect Res, Tubingen, Germany
Stephan Duparc - College Station Medical Center
Teferi Eshetu
Emmanuelle Espie - Epictr, Paris, France
Jean-Francois Etard
Abul M. Faiz - Mahidol University
Catherine O. Falade - University of Ibadan
Caterina I. Fanello - Mahidol University
Jean-Francois Faucher
Babacar Faye - College Station Medical Center
Oumar Faye - College Station Medical Center
Scott Filler - Global Fund Fight AIDS TB & Malaria, Geneva, Switzerland
Jennifer A. Flegg
Bakary Fofana - University of Bamako
Carole Fogg - University of Portsmouth
Nahla B. Gadalla
Oumar Gaye - College Station Medical Center
Blaise Genton
Peter W. Gething - University of Oxford
Jose P. Gil
Raquel Gonzalez
Francesco Grandesso - Epictr, Paris, France
Bryan Greenhouse - College Station Medical Center
Brian Greenwood - Supreme Council Of Health
Anastasia Grivoyannis - University of Washington
Philippe J. Guerin
Jean-Paul Guthmann - Inst Veille Sanit, Dept Malad Infect, St Maurice, France
Kamal Hamed - Novartis Pharmaceut, E Hanover, NJ USA
Sally Hamour - The Royal Free Hospital
Simon I. Hay
Eva Maria Hodel
Georgina S. Humphreys
Jimee Hwang
Maman L. Ibrahim - College Station Medical Center
Daddi Jima - Fed Minist Hlth, Addis Ababa, Ethiopia
Joel J. Jones - Minist Hlth & Social Welf, Natl Malaria Control Programme, Monrovia, Liberia
Vincent Jullien - Université Paris Cité
Elizabeth Juma - College Station Medical Center
Patrick S. Kachur - Ctr Dis Control & Prevent, Div Parasit Dis & Malaria, Malaria Branch, Atlanta, GA USA
Piet A. Kager - University of Amsterdam
Erasmus Kamugisha - Pontifícia Universidade Católica de São Paulo
Moses R. Kamya - Makerere University
Corine Karema - Minist Hlth, Malaria & Other Parasit Dis Div RBC, Kigali, Rwanda
Kassoum Kayentao - University of Bamako
Jean-Rene Kiechel - Drugs Neglected Dis initiat, Geneva, Switzerland
Fred Kironde - Makerere University
Poul-Erik Kofoed
Peter G. Kremsner
Sanjeev Krishna - University of London
Valerie Lameyre - Sanofi Aventis, Direct Acces Med Access Med, Gentilly, France
Bertrand Lell
Angeles Lima - University of Oxford
Michael Makanga - Tioga County Partnership for Community Health
ElFatih M. Malik - Federal Reserve
Kevin Marsh
Andreas Mårtensson
Achille Massougbodji - Univ Abomey Calavi, FSS, CERPAGE, Cotonou, Benin
Herve Menan - Univ Cocody, Fac Pharm, Dept Parasitol, Abidjan, Cote Ivoire
Didier Menard - Inst Pasteur Cambodia, Malaria Mol Epidemiol Unit, Phnom Penh, Cambodia
Clara Menendez
Petra F. Mens
Martin Meremikwu
Clarissa Moreira
Carolyn Nabasumba
Michael Nambozi - Trop Dis Res Ctr, Ndola, Zambia
Jean-Louis Ndiaye - College Station Medical Center
Billy E. Ngasala
Frederic Nikiema - Inst Rech Sci Sante, Bobo Dioulasso, Burkina Faso
Christian Nsanzabana
Francine Ntoumi
Mary Oguike - Supreme Council Of Health
Bernhards R. Ogutu - United States Army
Piero Olliaro
Sabah A. Omar - College Station Medical Center
Jean-Bosco Ouedraogo
Seth Owusu-Agyei - Kintampo Hlth Res Ctr, Kintampo, Ghana
Louis K. Penali - WorldWide Antimalarial Resistance Network WWARN W, Dakar, Senegal
Mbaye Pene - College Station Medical Center
Judy Peshu - Wellcome Trust
Patrice Piola - Inst Pasteur Madagascar, Epidemiol Unit, Antananarivo, Madagascar
Christopher V. Plowe - Supreme Council Of Health
Zul Premji - Muhimbili Univ Hlth & Allied Sci, Dept Parasitol, Dar Es Salaam, Tanzania
Ric N. Price
Milijaona Randrianarivelojosia - Inst Pasteur Madagascar, Malaria Res Unit, Antananarivo, Madagascar
Lars Rombo
Cally Roper - Supreme Council Of Health
Philip J. Rosenthal - College Station Medical Center
Issaka Sagara - University of Bamako
Albert Same-Ekobo - College Station Medical Center
Patrick Sawa - Int Ctr Insect Physiol & Ecol, Human Hlth Div, Mbita, Kenya
Henk D. F. H. Schallig - KIT Biomed Res, Royal Trop Inst, Amsterdam, Netherlands
Birgit Schramm - Epictr, Paris, France
Amadou Seck - WorldWide Antimalarial Resistance Network WWARN W, Dakar, Senegal
Seif A. Shekalaghe
Carol H. Sibley
Vronique Sinou - Aix-Marseille University
Sodiomon B. Sirima - CNRFP, Ouagadougou, Burkina Faso
Fabrice A. Som - Inst Rech Sci Sante, Bobo Dioulasso, Burkina Faso
Doudou Sow - College Station Medical Center
Sarah G. Staedke
Kasia Stepniewska
Colin J. Sutherland - Supreme Council Of Health
Todd D. Swarthout - College Station Medical Center
Khadime Sylla - College Station Medical Center
Ambrose O. Talisuna
Walter R. J. Taylor
Emmanuel A. Temu
Julie I. Thwing - Ctr Dis Control & Prevent, Div Parasit Dis & Malaria, Malaria Branch, Atlanta, GA USA
Roger C. K. Tine - College Station Medical Center
Halidou Tinto
Silva Tommasini - Sigma Tau Ind Farmaceut Riunite SpA, Rome, Italy
Offianan A. Toure - Inst Pasteur Cote Ivoire, Malariol Dept, Abidjan, Cote Ivoire
Johan Ursing
Michel T. Vaillant
Giovanni Valentini - Sigma Tau Ind Farmaceut Riunite SpA, Rome, Italy
Ingrid Van den Broek
Michele Van Vugt - University of Amsterdam
Stephen A. Ward - University of Liverpool
Peter A. Winstanley - University of Warwick
William Yavo
Adoke Yeka - Uganda Malaria Surveillance Project, Kampala, Uganda
Yah M. Zolia - Minist Hlth & Social Welf, Natl Malaria Control Programme, Monrovia, Liberia
Issaka Zongo - Inst Rech Sci Sante, Bobo Dioulasso, Burkina Faso
WWARN Artemisinin Based
Publication Details: BMC medicine, Vol.13(1), pp.212-212
Identifiers: 9928634808331
Academic Unit: Qassim University
Language: English
Resource Type: Journal article