Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treating Uncomplicated Malaria: A Randomized Trial to Guide Policy in Uganda
Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treating Uncomplicated Malaria: A Randomized Trial to Guide Policy in Uganda
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DOI：
10.1371/journal.pone.0002390
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发表时间：
2008-06-11
期刊：
影响因子：
3.7
通讯作者：
Bukirwa, Hasifa
中科院分区：
文献类型：
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作者：
Yeka, Adoke;Dorsey, Grant;Bukirwa, Hasifa
背景：乌干达最近采用蒿甲醚-苯芴醇（AL）作为推荐的无并发症疟疾的一线治疗。然而，AL有几个局限性，包括每日两次给药方案，建议与脂肪食物一起给药，以及在高传播地区治疗后不久再感染的高风险。双氢青蒿素-哌喹（DP）是一种新的替代青蒿素为基础的联合治疗，每日给药一次，并具有长期的治疗后预防效果。我们在卡农古（中度疟疾传播地区）比较了AL与DP的疗效和安全性。方法/主要发现：年龄6个月至10岁的无并发症恶性疟疾患者随机接受治疗，并随访42天。基因分型用于区分复发和新感染。在入组的414例患者中，408例完成了随访。与蒿甲醚-苯芴醇治疗的患者相比，双氢青蒿素-哌喹治疗的患者复发寄生虫血症的风险显著降低（33.2% vs. 12.2%;风险差异= 20.9%，95% CI 13.0-28.8%），但由于复发导致治疗失败的风险无统计学显著差异（5.8% vs. 2.0%;风险差异= 3.8%，95% CI -0.2-7.8%）。接受双氢青蒿素-哌喹治疗的患者在治疗后发生配子细胞血症的风险也较低（4.2% vs. 10.6%，p = 0.01）。这两种药物都是安全的且耐受性良好。结论/意义：DP非常有效，并且在操作上优于AL，因为DP的给药方案和要求不那么密集。应考虑在乌干达的抗疟治疗政策中使用双氢青蒿素-哌喹。
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.