An open, randomized comparison of artesunate plus mefloquine vs. dihydroartemisinin–piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in the Lao People's Democratic Republic (Laos)

doi:10.1111/j.1365-3156.2006.01671.x

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Wiley InterScience

Tropical Medicine & International Health

Volume 11 Issue 8, Pages 1157 - 1165

Published Online: 12 Jul 2006

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An open, randomized comparison of artesunate plus mefloquine vs. dihydroartemisinin–piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in the Lao People's Democratic Republic (Laos)

M. Mayxay ^1,2 , V. Thongpraseuth ³ , M. Khanthavong ³ , N. Lindegårdh ^4,5 , M. Barends ^5,6 , S. Keola ⁷ , T. Pongvongsa ⁸ , S. Phompida ³ , R. Phetsouvanh ³ , K. Stepniewska ^4,5 , N. J. White ^1,4,5,6 and P. N. Newton ^1,4

1 Wellcome Trust – Mahosot Hospital – Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR
2 Division of Postgraduate Studies and Research, Faculty of Medical Science, National University of Laos, Vientiane, Lao PDR
3 Centre of Malariology, Parasitology and Entomology, Vientiane, Lao PDR
4 Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK
5 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
6 Shoklo Malaria Research Unit, Mae Sot, Tak Province, Thailand
7 Phalanxay District Clinic, Savannakhet Province, Lao PDR
8 Savannakhet Provincial Malaria Station, Savannakhet Province, Lao PDR

Corresponding Author Paul N Newton, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. Tel./Fax: +856 21 24218; E-mail: paul@tropmedres.ac

KEYWORDS

Plasmodium falciparum • malaria • artemisinin-based combination therapy • dihydroartemisinin–piperaquine • Laos

Summary

Objective To determine the efficacy and safety of oral dihydroartemisinin–piperaquine (DP, Artekin^TM) in the treatment of uncomplicated Plasmodium falciparum malaria in southern Laos.

Methods An open, randomized clinical trial of oral artesunate–mefloquine (AM) vs. DP in 220 patients with acute uncomplicated falciparum malaria in Savannakhet Province, Laos.

Results The 42-day cure rates (95% CI), as determined by survival analysis and adjusted for reinfection, were excellent and similar for the two groups [99 (94–100)% and 100 (100–100)% for AM and DP, respectively]. The median (range) fever and parasite clearance times for the AM and DP groups were also similar [20 (4–63) h and 2 (1–4) days vs. 20 (7–57) and 2 (1–4) days, logrank P = 0.4 and 0.17, respectively]. There were more patients with at least one potential side effect following treatment in the AM group when compared with the DP group [64/110 (58%) vs. 48/110 (44%), respectively, P = 0.031].

Conclusion Dihydroartemisinin–piperaquine did not have superior efficacy to AM for the treatment of uncomplicated falciparum malaria in Laos but was associated with fewer adverse effects.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-3156.2006.01671.x About DOI