Evaluation of the Clinical Efficacy of Artemether-Lumefantrine as First Line Antimalarial Therapy after Twelve Years of Adoption in Nigeria
Keywords:
Clinical Efficacy, Artemether-lumefantrine, Acute Uncomplicated Malaria, Southwest NigeriaAbstract
ACT became the drug of first choice in the treatment of acute uncomplicated malaria in Nigeria in 2005. Diminished responsiveness of P. falciparum malaria to Artemether-lumefantrine (AL) has been reported in Nigeria. We evaluated the clinical efficacy of AL in the treatment of malaria, the prevalence of PfATPase6 gene, a molecular marker reported to be associated with artemisinin resistance and its relationship to treatment outcome in Ibadan, southwest Nigeria. In a prospective single arm clinical trial, 121 children aged 6 months to 10 years with confirmed falciparum malaria were enrolled and followed up for 28 days using the WHO protocol. Parasite DNA was extracted and sequenced to identify molecular markers. 64/121 (52.9%) were male and mean age was 77.9 ± 34.7 months. 92.6% (112/121) completed the study. Response of infection to treatment was prompt. Day-28 uncorrected ACPR was 84.8% (95/112). Seven paired samples were successfully genotyped for glurp, msp1 & msp2 markers. All cases of parasite recurrence were new infections. The PCR corrected cure rate at Day-28 was 91.1% (102/112). Hematological recovery was also good. AL was well tolerated. Only E431K mutation of the four reported ATPase-6 mutations was detected with a prevalence of 17%. There was no relationship between ATPase-6 mutation and response to therapy. AL remains safe and efficacious in the treatment of acute uncomplicated malaria in Ibadan, southwest Nigeria. Molecular markers of artemisinin resistance have been detected. This underscores the need to use ACTs in a disciplined manner in other to preserve its efficacy.