Mali study shows no evidence of delayed parasite clearance after oral artesunate treatment of malaria

09 July 2012

The American Journal of Tropical Medicine & Hygiene published an article based on research conducted as part of the EDCTP-funded WANECAM clinical trial, led by Dr Abdoulaye Djimdé (University of Bamako, Mali). The authors concluded that in Mali there is currently no evidence of delayed parasite clearance following oral treatment for uncomplicated malaria with artesunate, a synthetic derivative of artemisinin. The results contribute to the collection of baseline surveillance data on the emergence and spread of P. falciparum resistance in sub-Saharan Africa. There is rising concern over growing artemisinin resistance in South East Asia and its potential spread to sub-Saharan Africa.

Children with uncomplicated malaria were enrolled and treated for seven days of artesunate and followed for 28 days. Blood smears were done every eight hours until negative by light microscopy. Results were compared with a similar study conducted in the same village with high-intensity seasonal malaria transmission in 2002–2004. The polymerase chain reaction-corrected cure rate was found to be 100% and identical to 2002–2004. In the discussion authors stress that artesunate is not to be used as monotherapy for the treatment of uncomplicated malaria. Artesunate monotherapy is only justified in controlled conditions to get clear measurement of efficacy.

The study was primarily funded by EDCTP and by the West-African Network for Clinical Trials of Antimalarial drugs (WANECAM). Additional support was provided by the National Institutes of Health (NIH, USA) through the International Clinical Research Scholars and Fellows Program at Vanderbilt University and the American Relief and Recovery Act.

WANECAM
The WANECAM project provides an integrated approach to clinical trials, capacity building and networking in West-Africa. The overall objective of the project is the development of a sub-region (Burkina Faso, Guinea and Mali) equipped with state of the art clinical trial sites, laboratories, research teams and well characterized populations ready to undertake phase I–IV development of new drugs. The primary objective of the clinical study is to compare the incidence rate of uncomplicated malaria episodes in children and adults treated with repeated ACT therapy over a period of 2 years. In this three-arm study, pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DHA-PQP) will be compared to either artesunate/amodiaquine (AS/AQ) or artemether-lumefantrine (AL) (depending on the site location). PA and DHA-PQP are not compared.

The background to this project is the need for accurate incidence and drug resistance data to inform the national malaria control programmes in Burkina Faso, Mali and Guinea. Previous increase in resistance to cheap antimalarial drugs led the three countries to change their treatment guidelines and adopt artemisinin combination therapies (ACTs) as new first line therapy. In Mali and Burkina Faso AS/AQ and/or AL are the first line antimalarials while in Guinea the first line ACT is AS/AQ.

More information: