Changes in the treatment responses to artesunate-mefloquine on the northwestern border of Thailand during 13 years of continuous deployment.
Changes in the treatment responses to artesunate-mefloquine on the northwestern border of Thailand during 13 years of continuous deployment.
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DOI：
10.1371/journal.pone.0004551
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发表时间：
2009
期刊：
影响因子：
3.7
通讯作者：
Nosten, Francois
中科院分区：
文献类型：
--
作者：
Carrara, Verena Ilona;Zwang, Julien;Ashley, Elizabeth A.;Price, Ric N.;Stepniewska, Kasia;Barends, Marion;Brockman, Alan;Anderson, Tim;McGready, Rose;Phaiphun, Lucy;Proux, Stephane;van Vugt, Michele;Hutagalung, Robert;Lwin, Khin Maung;Phyo, Aung Pyae;Preechapornkul, Piyanuch;Imwong, Mallika;Pukrittayakamee, Sasithon;Singhasivanon, Pratap;White, Nicholas J.;Nosten, Francois
青蒿素联合治疗(ACT)被推荐作为全世界受疟疾影响的恶性疟疾的一线治疗方法。我们回顾了为期3天的甲氟喹和青蒿琥酯方案(MAS3)的疗效，该方案持续部署了13年，作为泰缅边境流离失所者营地和移民诊所的一线治疗。1995年至2007年间，有3,264名患者参加了前瞻性治疗试验，并接受了MAS3的治疗。持续在第二天的寄生虫血症患者的比例从2001年之前的4.5%显著增加到2002年以来的21.9%(p<；0.001)。寄生虫清除延迟与发生配子细胞症的风险增加相关(AOR = 2.29；95%CI，2.00-2.69，p = 0.002)。多年来，入院和携带时的配子细胞症也有所增加(p = 0.001，趋势测试，两者都是如此)。MAS3的疗效略有下降，但明显下降(危险比1.13；95%可信区间，1.07-1.19，p<；0.001)，尽管2007年的疗效保持在可接受的范围内：96.5%(95%可信区间，91.0-98.7)。恶性疟原虫对青蒿琥酯的体外敏感性在2002年之前显著增加，但此后下降到接近13年前的水平(2007年几何平均值：4.2nM/L；95%可信区间，3.2-5.5)。由pfmdr1拷贝数增加的寄生虫引起的感染比例从1996年的30%(12/40)上升到2006年的53%(24/45)(p = 0.012，趋势检验)。尽管13年来广泛密集部署，青蒿琥酯甲氟喹仍是该地区一种高效的抗疟疾治疗方法，但有证据表明抗药性略有增加。尤其令人担忧的是，青蒿琥酯的寄生虫学反应减慢，配子体携带量增加。
Artemisinin combination treatments (ACT) are recommended as first line treatment for falciparum malaria throughout the malaria affected world. We reviewed the efficacy of a 3-day regimen of mefloquine and artesunate regimen (MAS3), over a 13 year period of continuous deployment as first-line treatment in camps for displaced persons and in clinics for migrant population along the Thai-Myanmar border. 3,264 patients were enrolled in prospective treatment trials between 1995 and 2007 and treated with MAS3. The proportion of patients with parasitaemia persisting on day-2 increased significantly from 4.5% before 2001 to 21.9% since 2002 (p<0.001). Delayed parasite clearance was associated with increased risk of developing gametocytaemia (AOR = 2.29; 95% CI, 2.00–2.69, p = 0.002). Gametocytaemia on admission and carriage also increased over the years (p = 0.001, test for trend, for both). MAS3 efficacy has declined slightly but significantly (Hazards ratio 1.13; 95% CI, 1.07–1.19, p<0.001), although efficacy in 2007 remained well within acceptable limits: 96.5% (95% CI, 91.0–98.7). The in vitro susceptibility of P. falciparum to artesunate increased significantly until 2002, but thereafter declined to levels close to those of 13 years ago (geometric mean in 2007: 4.2 nM/l; 95% CI, 3.2–5.5). The proportion of infections caused by parasites with increased pfmdr1 copy number rose from 30% (12/40) in 1996 to 53% (24/45) in 2006 (p = 0.012, test for trend). Artesunate-mefloquine remains a highly efficacious antimalarial treatment in this area despite 13 years of widespread intense deployment, but there is evidence of a modest increase in resistance. Of particular concern is the slowing of parasitological response to artesunate and the associated increase in gametocyte carriage.
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影响因子：
3.3
作者：
Ashley, Elizabeth A.;Lwin, Khin Maung;Nosten, Francois
通讯作者：
Nosten, Francois
影响因子：
6.4
作者：
Ashley, EA;Krudsood, S;White, NJ
通讯作者：
White, NJ
影响因子：
11.8
作者：
Ashley, EA;McGready, R;Nosten, F
通讯作者：
Nosten, F
DOI：
10.1098/rstb.1999.0426
发表时间：
1999-04-29
影响因子：
6.3
作者：
White, N
通讯作者：
White, N
DOI：
10.1016/0035-9203(94)90303-4
发表时间：
1994-03-01
影响因子：
2.2
作者：
LUXEMBURGER, C;TERKUILE, FO;WHITE, NJ
通讯作者：
WHITE, NJ