Victor S Koko, Laura Skrip, Odell Kumeh, Trokon Washington, Mamadou O Diallo, Jessica Kafuko, Uwem Inyang, Gabriel F Ponce de León, Zhiyong Zhou, Veronika R Laird, Jethro Zawolo, Birhanu Getahun, Wahdae-Mai Harmon-Gray, Mateusz Plucinski, Jonathan S Schultz
{"title":"2022-2023年利比里亚青蒿琥酯-阿莫地喹（ASAQ）和蒿甲醚-氨苯曲明（AL）治疗无并发症恶性疟原虫疟疾的疗效和安全性比较","authors":"Victor S Koko, Laura Skrip, Odell Kumeh, Trokon Washington, Mamadou O Diallo, Jessica Kafuko, Uwem Inyang, Gabriel F Ponce de León, Zhiyong Zhou, Veronika R Laird, Jethro Zawolo, Birhanu Getahun, Wahdae-Mai Harmon-Gray, Mateusz Plucinski, Jonathan S Schultz","doi":"10.1186/s12936-025-05576-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Artemether-lumefantrine (AL) is currently the first-line treatment for uncomplicated Plasmodium falciparum malaria in Liberia. To ensure antimalarial treatments are effective, the World Health Organization (WHO) recommends routinely testing the efficacy of oral artemisinin-based combination therapy (ACT) for uncomplicated malaria using therapeutic efficacy studies (TES) every two years. The most recent TES in Liberia conducted from December 2017 to May 2018 reported a PCR-corrected adequate clinical and parasitological response (ACPR) of 90.2% in Bensonville and 92.7% in Saclepea for artesunate-amodiaquine (ASAQ), and 100% in Kakata and Sinje for AL. Due to these findings AL was prioritized over ASAQ as the first-line ACT in Liberia. However, ASAQ is commonly available in Liberia and remains highly efficacious in other West African countries.</p><p><strong>Methods: </strong>The therapeutic efficacy of AL and ASAQ were evaluated using the standard WHO TES protocol in Saclepea and Sinje, Liberia, from August 2022 to July 2023. Eligible children aged 6 - 59 months with uncomplicated P. falciparum malaria infection (2,000-200,000 asexual parasites/μL) were recruited, treated with AL or ASAQ at each site, and monitored clinically and parasitologically for 28 days.</p><p><strong>Results: </strong>A total of 1,630 children were screened for eligibility and 305 were enrolled. Among enrolled children, 152 were treated with AL (78 in Sacleapea and 74 in Sinje) and 153 were treated with ASAQ (77 in Sacleapea and 76 in Sinje). Of the enrolled children, 299 (98%) reached a study endpoint or completed the 28 days of follow up. No adverse events were reported for either AL or ASAQ during the study period. The proportion of participants with parasitaemia on day 3 of follow up was 1.3% (2/153) for ASAQ, and 0% (0/151) treated with AL. The PCR-corrected ACPR at day 28 was 100% in Saclepea and 95.9% (95CI 88.0%-98.7%) in Sinje for AL, and 100% in Saclepea and 94.4% (95CI 85.9%-97.9%) in Sinje for ASAQ.</p><p><strong>Conclusion: </strong>The PCR-corrected ACPR efficacy greater than the 90% WHO threshold, and day 3 slide positivity rate demonstrate that AL and ASAQ are both effective treatments for uncomplicated malaria in Liberia.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":"24 1","pages":"319"},"PeriodicalIF":3.0000,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and safety of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) for the treatment of uncomplicated Plasmodium falciparum malaria in Liberia, 2022-2023.\",\"authors\":\"Victor S Koko, Laura Skrip, Odell Kumeh, Trokon Washington, Mamadou O Diallo, Jessica Kafuko, Uwem Inyang, Gabriel F Ponce de León, Zhiyong Zhou, Veronika R Laird, Jethro Zawolo, Birhanu Getahun, Wahdae-Mai Harmon-Gray, Mateusz Plucinski, Jonathan S Schultz\",\"doi\":\"10.1186/s12936-025-05576-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Artemether-lumefantrine (AL) is currently the first-line treatment for uncomplicated Plasmodium falciparum malaria in Liberia. To ensure antimalarial treatments are effective, the World Health Organization (WHO) recommends routinely testing the efficacy of oral artemisinin-based combination therapy (ACT) for uncomplicated malaria using therapeutic efficacy studies (TES) every two years. The most recent TES in Liberia conducted from December 2017 to May 2018 reported a PCR-corrected adequate clinical and parasitological response (ACPR) of 90.2% in Bensonville and 92.7% in Saclepea for artesunate-amodiaquine (ASAQ), and 100% in Kakata and Sinje for AL. Due to these findings AL was prioritized over ASAQ as the first-line ACT in Liberia. However, ASAQ is commonly available in Liberia and remains highly efficacious in other West African countries.</p><p><strong>Methods: </strong>The therapeutic efficacy of AL and ASAQ were evaluated using the standard WHO TES protocol in Saclepea and Sinje, Liberia, from August 2022 to July 2023. Eligible children aged 6 - 59 months with uncomplicated P. falciparum malaria infection (2,000-200,000 asexual parasites/μL) were recruited, treated with AL or ASAQ at each site, and monitored clinically and parasitologically for 28 days.</p><p><strong>Results: </strong>A total of 1,630 children were screened for eligibility and 305 were enrolled. Among enrolled children, 152 were treated with AL (78 in Sacleapea and 74 in Sinje) and 153 were treated with ASAQ (77 in Sacleapea and 76 in Sinje). Of the enrolled children, 299 (98%) reached a study endpoint or completed the 28 days of follow up. No adverse events were reported for either AL or ASAQ during the study period. The proportion of participants with parasitaemia on day 3 of follow up was 1.3% (2/153) for ASAQ, and 0% (0/151) treated with AL. The PCR-corrected ACPR at day 28 was 100% in Saclepea and 95.9% (95CI 88.0%-98.7%) in Sinje for AL, and 100% in Saclepea and 94.4% (95CI 85.9%-97.9%) in Sinje for ASAQ.</p><p><strong>Conclusion: </strong>The PCR-corrected ACPR efficacy greater than the 90% WHO threshold, and day 3 slide positivity rate demonstrate that AL and ASAQ are both effective treatments for uncomplicated malaria in Liberia.</p>\",\"PeriodicalId\":18317,\"journal\":{\"name\":\"Malaria Journal\",\"volume\":\"24 1\",\"pages\":\"319\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-10-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Malaria Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12936-025-05576-3\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Malaria Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12936-025-05576-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Efficacy and safety of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) for the treatment of uncomplicated Plasmodium falciparum malaria in Liberia, 2022-2023.
Background: Artemether-lumefantrine (AL) is currently the first-line treatment for uncomplicated Plasmodium falciparum malaria in Liberia. To ensure antimalarial treatments are effective, the World Health Organization (WHO) recommends routinely testing the efficacy of oral artemisinin-based combination therapy (ACT) for uncomplicated malaria using therapeutic efficacy studies (TES) every two years. The most recent TES in Liberia conducted from December 2017 to May 2018 reported a PCR-corrected adequate clinical and parasitological response (ACPR) of 90.2% in Bensonville and 92.7% in Saclepea for artesunate-amodiaquine (ASAQ), and 100% in Kakata and Sinje for AL. Due to these findings AL was prioritized over ASAQ as the first-line ACT in Liberia. However, ASAQ is commonly available in Liberia and remains highly efficacious in other West African countries.
Methods: The therapeutic efficacy of AL and ASAQ were evaluated using the standard WHO TES protocol in Saclepea and Sinje, Liberia, from August 2022 to July 2023. Eligible children aged 6 - 59 months with uncomplicated P. falciparum malaria infection (2,000-200,000 asexual parasites/μL) were recruited, treated with AL or ASAQ at each site, and monitored clinically and parasitologically for 28 days.
Results: A total of 1,630 children were screened for eligibility and 305 were enrolled. Among enrolled children, 152 were treated with AL (78 in Sacleapea and 74 in Sinje) and 153 were treated with ASAQ (77 in Sacleapea and 76 in Sinje). Of the enrolled children, 299 (98%) reached a study endpoint or completed the 28 days of follow up. No adverse events were reported for either AL or ASAQ during the study period. The proportion of participants with parasitaemia on day 3 of follow up was 1.3% (2/153) for ASAQ, and 0% (0/151) treated with AL. The PCR-corrected ACPR at day 28 was 100% in Saclepea and 95.9% (95CI 88.0%-98.7%) in Sinje for AL, and 100% in Saclepea and 94.4% (95CI 85.9%-97.9%) in Sinje for ASAQ.
Conclusion: The PCR-corrected ACPR efficacy greater than the 90% WHO threshold, and day 3 slide positivity rate demonstrate that AL and ASAQ are both effective treatments for uncomplicated malaria in Liberia.
期刊介绍：
Malaria Journal is aimed at the scientific community interested in malaria in its broadest sense. It is the only journal that publishes exclusively articles on malaria and, as such, it aims to bring together knowledge from the different specialities involved in this very broad discipline, from the bench to the bedside and to the field.
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