Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria -associated anaemia in Nigerian children during seven years of adoption as first-line treatments

• Published in: Infectious diseases of poverty Vol. 6; no. 1; p. 36
• Main Authors: Sowunmi, Akintunde, Akano, Kazeem, Ntadom, Godwin, Ayede, Adejumoke I, Ibironke, Folasade O, Aderoyeje, Temitope, Adewoye, Elsie O, Fatunmbi, Bayo, Oguche, Stephen, Okafor, Henrietta U, Watila, Ismaila, Meremikwu, Martin, Agomo, Philip, Ogala, William, Agomo, Chimere, Folarin, Onikepe A, Gbotosho, Grace O, Happi, Christian T
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.02.2017; BioMed Central
• Subjects: Adolescent; Amodiaquine - therapeutic use; Anemia; Anemia - pathology; Antimalarials - therapeutic use; Antiparasitic agents; Artemether, Lumefantrine Drug Combination; Artemisinins - therapeutic use; Care and treatment; Child; Child, Preschool; Complications and side effects; Development and progression; Drug Combinations; Ethanolamines - therapeutic use; Female; Fluorenes - therapeutic use; Hematocrit; Humans; Infant; Malaria; Malaria, Falciparum - complications; Malaria, Falciparum - drug therapy; Male; Nigeria; Patient outcomes; Treatment Outcome; Nigeria; Haematocrit conservation; Artemisinin-based combination treatments; Children; Malaria-associated anaemia; Nigeria
• ISSN: 2049-9957; 2095-5162; 2049-9957
• DOI: 10.1186/s40249-016-0217-7

Artemisinin-based combination treatments (ACTs) are the first-line treatments of uncomplicated Plasmodium falciparum malaria in many endemic areas but there are few evaluation of their efficacy in anaemic malarious children. Therapeutic efficacy of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine was evaluated in 437 anaemic and 909 non-anaemic malarious children following treatment during a seven-year period (2008-2014). Patterns of temporal changes in haematocrit were classified based on haematocrit values <30% and ≥30%. Kinetics of the disposition of the deficit in haematocrit from 30% following treatment were evaluated using a non-compartment model. PCR-corrected parasitological efficacy 28 days after start of treatment was significantly higher in artesunate-amodiaquine- compared to artemether-lumefantrine-treated children [97% (95%CI: 92.8-100) versus 96.4% (95%CI: 91.3-99.4), P = 0.02], but it was similar in non-anaemic and anaemic children. Fall in haematocrit/1 000 asexual parasites cleared from peripheral blood was significantly greater at lower compared to higher parasitaemias (P < 0.0001), and in non-anaemic compared to anaemic children (P = 0.007). In anaemic children at presentation, mean anaemia recovery time (AnRT) was 15.4 days (95%CI: 13.3-17.4) and it did not change over the years. Declines in haematocrit deficits from 30% were monoexponential with mean estimated half-time of 1.4 days (95%CI: 1.2-1.6). Anaemia half-time (t ) correlated positively with AnRT in the same patients (r = 0.69, P < 0.0001). Bland-Altman analysis of 10 multiples of t and AnRT showed narrow limit of agreement with insignificant bias (P = 0.07) suggesting both can be used interchangeably in the same patients. Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated P. falciparum infections in non-anaemic and anaemic Nigerian children in the last 7 years of adoption as first-line treatments. These ACTs may also conserve haematocrit at high parasitaemias and in anaemic children. Pan African Clinical Trial Registry PACTR201508001188143 , 3 July 2015; PACTR201510001189370 , 3 July 2015; PACTR201508001191898 , 7 July 2015 and PACTR201508001193368 , 8 July 2015.