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Malaria transmission after artemether-lumefantrine and dihydroartemisinin-piperaquine: a randomized trial
Patrick Sawa1, Seif A Shekalaghe, Chris J Drakeley
1Human Health Division, International Centre for Insect Physiology and Ecology, Mbita Point, Nairobi, Kenya.
Insights
Artemether-lumefantrine (AL) showed lower malaria transmission to mosquitoes compared to dihydroartemisinin-piperaquine (DP). DP provided longer protection, but AL reduced gametocyte carriage more effectively.
Area of Science:
- Malariology
- Infectious Diseases
- Parasitology
Background:
- Artemisinin-based combination therapy (ACT) is crucial for reducing malaria transmission.
- The comparative impact of different ACTs on malaria transmission remains unclear.
Purpose of the Study:
- To compare the effects of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) on malaria transmission in children.
- To evaluate gametocyte carriage and infectiousness after treatment with AL versus DP.
Main Methods:
- A randomized trial involving 298 children with uncomplicated falciparum malaria in Kenya.
- Comparison of AL and DP treatments.
- Molecular methods and mosquito-feeding assays to assess gametocyte carriage and infectiousness.
Main Results:
- Dihydroartemisinin-piperaquine (DP) showed a significantly lower risk of recurrent parasitemia (3.7%) compared to artemether-lumefantrine (AL) (20.7%).
- Mean gametocyte carriage duration was longer with DP (15.3 days) than AL (5.5 days).
- Malaria transmission to mosquitoes was lower from AL-treated children, though not statistically significant (P = .06), but oocyst burden was significantly lower (P = .005).
Conclusions:
- Dihydroartemisinin-piperaquine (DP) offers a longer prophylactic period post-treatment.
- Artemether-lumefantrine (AL) demonstrates a greater reduction in gametocyte carriage and subsequent malaria transmission to mosquitoes.
Background:
Artemisinin-based combination therapy (ACT) reduces the potential for malaria transmission, compared with non-ACTs. It is unclear whether this effect differs between ACTs.
Methods:
A total of 298 children (age, 6 months to 10 years) with uncomplicated falciparum malaria were randomized to artemether-lumefantrine (AL; n = 153) or dihydroartemisinin-piperaquine (DP; n = 145) in Mbita, a community in western Kenya. Gametocyte carriage was determined by molecular methods on days 0, 1, 2, 3, 7, 14, 28, and 42 after treatment initiation. The gametocyte infectiousness to mosquitoes was determined by mosquito-feeding assays on day 7 after beginning therapy.
Results:
The cumulative risk of recurrent parasitemia on day 42 after initiation of treatment, unadjusted by polymerase chain reaction findings, was 20.7% (95% confidence interval [CI], 14.4-28.2) for AL, compared with 3.7% (95% CI, 1.2-8.5) for DP (P < .001). The mean duration of gametocyte carriage was 5.5 days (95% CI, 3.6-8.5) for AL and 15.3 days (95% CI, 9.7-24.2) for DP (P = .001). The proportion of mosquitoes that became infected after feeding on blood from AL-treated children was 1.88% (43 of 2293), compared with 3.50% (83 of 2371) for those that fed on blood from DP-treated children (P = .06); the oocyst burden among mosquitoes was lower among those that fed on blood from AL-treated children (P = .005) CONCLUSIONS: While DP was associated with a longer prophylactic time after treatment, gametocyte carriage and malaria transmission to mosquitoes was lower after AL treatment.
Clinical Trials Registration:
NCT00868465.
