Treatment with Coartem (artemether-lumefantrine) in Papua New Guinea

Overview

Journal Am J Trop Med Hyg

Specialty Tropical Medicine

Date 2010 Mar 30

PMID 20348494

Citations 12

Authors

Sonja Schoepflin

Enmoore Lin

Benson Kiniboro

Jeana T DaRe

Rajeev K Mehlotra

Peter A Zimmerman

Ivo Mueller

Ingrid Felger

Affiliations

Soon will be listed here.

Abstract

A recent drug efficacy trial reported Coartem (artemether-lumefantrine) to be highly effective against Plasmodium falciparum in children less than 5 years of age in Papua New Guinea (PNG). In contrast, we have observed high levels of treatment failures in non-trial conditions in a longitudinal cohort study in the same age group in PNG. Recrudescences were confirmed by genotyping of three different marker genes to provide optimal discrimination power between parasite clones. After excluding genetic host factors by genotyping potentially relevant cytochrome P450 loci, the high number of treatment failures in our study is best explained by poor adherence to complex dosing regimens in combination with insufficient fat supplementation, which are both crucial parameters for the outcome of Coartem treatment. In contrast to the situation in classic drug trials with ideal treatment conditions, our field survey highlights potential problems with unsupervised usage of Coartem in routine clinical practice and under program conditions.

Citing Articles

Asymptomatic recrudescence after artemether-lumefantrine treatment for uncomplicated falciparum malaria: a systematic review and meta-analysis.

Mumtaz R, Okell L, Challenger J Malar J. 2020; 19(1):453.

PMID: 33298080 PMC: 7724891. DOI: 10.1186/s12936-020-03520-1.

Assessing the impact of imperfect adherence to artemether-lumefantrine on malaria treatment outcomes using within-host modelling.

Challenger J, Bruxvoort K, Ghani A, Okell L Nat Commun. 2017; 8(1):1373.

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Efficacy and safety of fixed-dose artesunate-amodiaquine vs. artemether-lumefantrine for repeated treatment of uncomplicated malaria in Ugandan children.

Yeka A, Lameyre V, Afizi K, Fredrick M, Lukwago R, Kamya M PLoS One. 2014; 9(12):e113311.

PMID: 25436614 PMC: 4249977. DOI: 10.1371/journal.pone.0113311.

Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment.

Betson M, Sousa-Figueiredo J, Atuhaire A, Arinaitwe M, Adriko M, Mwesigwa G Parasitology. 2014; 141(14):1880-90.

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Optimizing the programmatic deployment of the anti-malarials artemether-lumefantrine and dihydroartemisinin-piperaquine using pharmacological modelling.

Hodel E, Kay K, Hayes D, Terlouw D, Hastings I Malar J. 2014; 13:138.

PMID: 24708571 PMC: 4036747. DOI: 10.1186/1475-2875-13-138.

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