Unsupervised intake of Artesunate + Amodiaquine versus Artemether-Lumefantrine for the treatment of uncomplicated falciparum malaria in Burkina Faso

Abstract

Since the implementation of the artemisinine based combination therapies (ACTs), very few studies have investigated their effectiveness when they are administered in real life conditions. We report here the results of a study conducted in Nanoro, Burkina Faso to assess the effectiveness of the unsupervised intake of Artesunate + Amodiaquine (AS+AQ) versus Artemether-Lumefantrine (AL) for the treatment of uncomplicated falciparum malaria. In total 47,4 % (165/348) of screened children were enrolled (84 in the AL arm and 81 in the AS+AQ arm). The day 28 PCR unadjusted total treatment failures rate was 35,9 % in the AS+AQ arm and 53 % in the AL arm (RR = 0,69  ; IC95 % [0,49-0,98) p = 0,04). After PCR correction the rate of Adequate Clinicat and Parasitological Response (ACPR) was 85,9 % in the AS+AQ arm and 77,l % in the AL arm (RR = 1,40  ; IC95 % [0,85 - 2,30] ; p = 0,22). At day 42, the two arms had similar efficacy both PCR unadjusted and adjusted (RR = 1,1 ; IC95 % [0,75 - 1,62] ; p = 0,75). The mean value of hemoglobin was similar in the two arms at day 42 with 9,97 ± 1,39 g/dl in the AL arm and 9,87 ± 1,81 g/dl in the ASAQ arm (p = 0,77). The two arms showed a good tolerability and safety pro­ file. In conclusion, with an ACPR rate of less than 90 %, the effectiveness of the two treatments was not satisfactory when they are administered in real life conditions. There is a need of testing in the same conditions ail other alternatives for the treatment of uncomplicated malaria in addition to AL and AS+AQ.