Artemisinin Derivative-containing Therapies and Abnormal Hemoglobin: Do We Need to Adapt the Treatment?

Overview

Journal Parasite

Specialty Parasitology

Date 2021 Sep 27

PMID 34569928

Citations 2

Authors

Eric A Gbessi

Offianan A Toure

Albert Gnondjui

Tossea S Koui

Baba Coulibaly

Berenger A Ako

Nguessan L Tiacoh

Serge-Brice Assi

Ibrahima Sanogo

Didier-Paulin Sokouri

Ronan Jambou

Affiliations

Soon will be listed here.

Abstract

Background: Artemisinin-based treatment in malaria patients with abnormal hemoglobin may be ineffective because of their genetic particularity, which could lead to resistance. The main purpose of this study was to assess the effect of artemisinin derivatives on in vivo parasite clearance according to erythrocyte variants. In vivo response was investigated through retrospective data obtained over a 42-day artemether-lumefantrine/artesunate amodiaquine efficacy protocol conducted from 2012 to 2016.

Results: A total of 770 patients in Côte d'Ivoire attending the hospitals of Anonkoua-koute (Abidjan), Petit Paris (Korhogo), Libreville (Man), Dar es salam (Bouaké), Ayamé and Yamoussoukro with acute uncomplicated falciparum malaria were selected for successful hemoglobin typing. HbAS, HbSS, HbAC, and HbSC genotypes were found. Parasite clearance time was obtained for 414 patients. In the population with abnormal hemoglobin, parasite densities on admission and parasite clearance rates were significantly lower in the HbSC group compared to HbAA (p = 0.02 and p = 0.007, respectively). After PCR correction on day 42, the acute treatment rate was 100% for each group. Parasite half-life and time for initial parasitaemia to decline by 50 and 99% were longer for the HbSC group (p < 0.05). The study also investigated the prevalence of K13-propeller polymorphisms across different hemoglobin genotype groups. A total of 185 and 63 samples were sequenced in the HbAA group and patients with abnormal Hb, respectively. Only two nonsynonymous mutations D559N and V510M were found in the HbAA group.

Conclusion: Although this study proved good efficacy of artemether-lumefantrine and artesunate amodiaquine in the treatment of uncomplicated Plasmodium falciparum malaria in patients with abnormal hemoglobin, the increased delay of parasite clearance may represent a threat to health in these patients in relation with sickle cell crisis, which could support selection of parasites resistant to artemisinin.

Citing Articles

In vitro delayed response to dihydroartemisinin of malaria parasites infecting sickle cell erythocytes.

Gnondjui A, Toure O, Ako B, Koui T, Assohoun S, Gbessi E Malar J. 2024; 23(1):9.

PMID: 38178227 PMC: 10768257. DOI: 10.1186/s12936-023-04819-5.

Clinical and laboratory characteristics of children with sickle cell disease on hydroxyurea treated with artemether-lumefantrine for acute uncomplicated malaria.

Segbefia C, Amponsah S, Afrane A, Nyarko M, Brew Y, Salifu N Front Med (Lausanne). 2023; 10:1291330.

PMID: 38076253 PMC: 10701543. DOI: 10.3389/fmed.2023.1291330.

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