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Am. J. Trop. Med. Hyg., 79(5), 2008, pp. 655-661
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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A Randomized Trial of Artesunate-Mefloquine versus Artemether-Lumefantrine for Treatment of Uncomplicated Plasmodium falciparum Malaria in Mali

Issaka Sagara*, Abdoulbaki Diallo, Mamady Kone, Modibo Coulibaly, Sory Ibrahima Diawara, Ousmane Guindo, Hamma Maiga, Mohamed Balla Niambele, Mady Sissoko, Alassane Dicko, Abdoulaye Djimde, AND Ogobara K. Doumbo
Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Bamako, Mali

The choice of appropriate artemisin-based combination therapy depends on several factors (cost, efficacy, safety, reinfection rate, and simplicity of administration). In this study, we tested the hypothesis that artesunate-mefloquine (ArtequinTM) is as efficacious as artemether-lumefantrine (Coartem®) in treatment of uncomplicated Plasmodium falciparum malaria. The study was carried out from August 2004 through February 2005 in Kambila, Mali. Subjects with weights ≥ 10 kg and uncomplicated malaria were enrolled. Artesunate-mefloquine was given once a day for three days and artemether/lumefantrine twice a day for three days. A total of 470 (235 in each arm) patients were enrolled. The unadjusted 28-day cure rate was higher in artesunate-mefloquine arm than in the artemether-lumefantrine arm (79.7% versus 67.8%; P < 0.004). After correction for reinfection, the 28-day cure rates were similar in the two groups (96.04% versus 96.93%). Artesunate-mefloquine is well-tolerated and is as effective as artemether-lumefantrine for the treatment of P. falciparum malaria. Artesunate-mefloquine also prevented more new infections.

Received August 10, 2007. Accepted for publication June 20, 2008.

Acknowledgments: We are grateful to all study subjects for participating in this study; the staff of the Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali, for developing the protocol and providing the research team and logistical support.

Financial support: This study was supported by Pharmatech Inc. (Denver, CO) and the local French West African representative of Mepha Ltd. Pharmatech also donated the AS + MEF used in the study.

* Address correspondence to Issaka Sagara, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, PO Box 1805, Point G, Bamako, Mali. E-mail: isagara{at}mrtcbko.org

Authors’ addresses: Issaka Sagara, Abdoulbaki Diallo, Mamady Kone, Modibo Coulibaly, Sory Ibrahima Diawara, Ousmane Guindo, Hamma Maiga, Mohamed Balla Niambele, Mady Sissoko, Alassane Dicko, Abdoulaye Djimde, and Ogobara K. Doumbo, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, PO Box 1805, Point G, Bamako, Mali, Tel: 223-222-8109, Fax: 223-222-4987, E-mails: isagara{at}mrtcbko.org, abdoulbaki{at}mrtcbko.org, mamady{at}mrtcbko.org, cmodibo{at}mrtcbko.org, sdiawara{at}mrtcbko.org, guindoous{at}mrtcbko.org, hmaiga{at}mrtcbko.org, jballa{at}mrtcbko.org, mady{at}mrtcbko.org, adicko{at}mrtcbko.org, adjimde{at}mrtcbko.org, and okd{at}mrtcbko.org.

Reprint requests: Ogobara K. Doumbo, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, PO Box 1805, Point G, Bamako, Mali.




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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.