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Open Access Highly Accessed Research article

Monitoring the efficacy and safety of three artemisinin based-combinations therapies in Senegal: results from two years surveillance

Khadime Sylla*, Annie Abiola, Roger Clément Kouly Tine, Babacar Faye, Doudou Sow, Jean Louis Ndiaye, Magatte Ndiaye, Aminata Colé LO, Kuaku Folly, Léon Amath Ndiaye and Oumar Gaye

Author Affiliations

Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP de Dakar, Dakar, Senegal

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BMC Infectious Diseases 2013, 13:598  doi:10.1186/1471-2334-13-598

Published: 20 December 2013

Abstract

Background

Malaria remains a major public health problem in developing countries. Then in these countries prompt access to effective antimalarial treatment such as Artemisinin based-Combination Therapies (ACT) proves to be an essential tool for controlling the disease. In Senegal, since 2006 a nationwide scaling up program of ACT is being implemented. In this context it has become relevant to monitor ACT efficacy and provide recommendations for the Senegalese national malaria control program.

Methods

An open randomized trial was conducted during two malaria transmission seasons (2011 and 2012) to assess the efficacy and safety of three combinations: dihydro-artemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ). The primary end point of the study was represented by a PCR adjusted adequate clinical and parasitological response (ACPR) at day 28. Secondary end points included: (i) a ACPR at days 35 and 42, (ii) a parasite and fever clearance time, (iii) ACTs safety and tolerability. The 2003 WHO’s protocol for antimalarial drug evaluation was used to assess each outcome.

Results

Overall, 534 patients were randomized selected to receive, either ASAQ (n = 180), AL (n = 178) or DHAPQ (n = 176). The PCR adjusted ACPR at day 28 was 99.41% for the group ASAQ, while that was 100% in the AL and DHAPQ groups (p = 0.37). The therapeutic efficacy was evaluated at 99.37% in the ASAQ arm versus 100% in AL and DHAPQ arm at day 35 (p = 0.37). At day 42, the ACPR was 99.27% in the ASAQ group versus 100% for both AL and DHAPQ groups, (p = 0.36). No serious adverse event was noted during the study period. Also a similar safety profile was noted in the 3 study groups.

Conclusion

In the context of scaling up of ACTs in Senegal, ASAQ, AL and DHAPQ are highly effective and safe antimalarial drugs. However, it’s remains important to continue to monitor their efficacy.

Trial registration

PACTR 201305000552290.

Keywords:
Artemisinin combination therapy; Malaria; Plasmodium falciparum; Senegal