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Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treating Uncomplicated Malaria: A Randomized Trial to Guide Policy in Uganda

Author

Listed:
  • Adoke Yeka
  • Grant Dorsey
  • Moses R Kamya
  • Ambrose Talisuna
  • Myers Lugemwa
  • John Bosco Rwakimari
  • Sarah G Staedke
  • Philip J Rosenthal
  • Fred Wabwire-Mangen
  • Hasifa Bukirwa

Abstract

Background: Uganda recently adopted artemether-lumefantrine (AL) as the recommended first-line treatment for uncomplicated malaria. However, AL has several limitations, including a twice-daily dosing regimen, recommendation for administration with fatty food, and a high risk of reinfection soon after therapy in high transmission areas. Dihydroartemisinin-piperaquine (DP) is a new alternative artemisinin-based combination therapy that is dosed once daily and has a long post-treatment prophylactic effect. We compared the efficacy and safety of AL with DP in Kanungu, an area of moderate malaria transmission. Methodology/Principal Findings: Patients aged 6 months to 10 years with uncomplicated falciparum malaria were randomized to therapy and followed for 42 days. Genotyping was used to distinguish recrudescence from new infection. Of 414 patients enrolled, 408 completed follow-up. Compared to patients treated with artemether-lumefantrine, patients treated with dihydroartemisinin-piperaquine had a significantly lower risk of recurrent parasitaemia (33.2% vs. 12.2%; risk difference = 20.9%, 95% CI 13.0–28.8%) but no statistically significant difference in the risk of treatment failure due to recrudescence (5.8% vs. 2.0%; risk difference = 3.8%, 95% CI −0.2–7.8%). Patients treated with dihydroartemisinin-piperaquine also had a lower risk of developing gametocytaemia after therapy (4.2% vs. 10.6%, p = 0.01). Both drugs were safe and well tolerated. Conclusions/Significance: DP is highly efficacious, and operationally preferable to AL because of a less intensive dosing schedule and requirements. Dihydroartemisinin-piperaquine should be considered for a role in the antimalarial treatment policy of Uganda. Trial Registration: Controlled-Trials.com ISRCTN75606663

Suggested Citation

  • Adoke Yeka & Grant Dorsey & Moses R Kamya & Ambrose Talisuna & Myers Lugemwa & John Bosco Rwakimari & Sarah G Staedke & Philip J Rosenthal & Fred Wabwire-Mangen & Hasifa Bukirwa, 2008. "Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treating Uncomplicated Malaria: A Randomized Trial to Guide Policy in Uganda," PLOS ONE, Public Library of Science, vol. 3(6), pages 1-7, June.
    • Handle: RePEc:plo:pone00:0002390
    DOI: 10.1371/journal.pone.0002390
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    1. Moses R Kamya & Adoke Yeka & Hasifa Bukirwa & Myers Lugemwa & John B Rwakimari & Sarah G Staedke & Ambrose O Talisuna & Bryan Greenhouse & François Nosten & Philip J Rosenthal & Fred Wabwire-Mangen & , 2007. "Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treatment of Malaria: A Randomized Trial," PLOS Clinical Trials, Public Library of Science, vol. 2(5), pages 1-9, May.
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    1. Adoke Yeka & James Tibenderana & Jane Achan & Umberto D'Alessandro & Ambrose O Talisuna, 2013. "Efficacy of Quinine, Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine as Rescue Treatment for Uncomplicated Malaria in Ugandan Children," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-8, January.
    2. Quique Bassat & Modest Mulenga & Halidou Tinto & Patrice Piola & Steffen Borrmann & Clara Menéndez & Michael Nambozi & Innocent Valéa & Carolyn Nabasumba & Philip Sasi & Antonella Bacchieri & Marco Co, 2009. "Dihydroartemisinin-Piperaquine and Artemether-Lumefantrine for Treating Uncomplicated Malaria in African Children: A Randomised, Non-Inferiority Trial," PLOS ONE, Public Library of Science, vol. 4(11), pages 1-10, November.

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