Treatment of Acute Uncomplicated Falciparum Malaria with Artemether-Lumefantrine in Non-immune Populations: A Safety, Efficacy, and Pharmacokinetic Study

Christoph Hatz Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Jaime Soto Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Hans Dieter Nothdurft Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Thomas Zoller Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Thomas Weitzel Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Louis Loutan Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Francois Bricaire Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Frederick Gay Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Gerd-Dieter Burchard Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Kim Andriano Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Gilbert Lefèvre Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Patricia Ibarra De Palacios Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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Blaise Genton Medical Department, Swiss Tropical Institute, Basel, Switzerland; CIBIC, Centro de Investigaciones Bioclínicas, Bogotá, Colombia; Department of Tropical Medicine and Infectious Diseases, University of Munich, Munich, Germany; University Hospital Charité, Berlin, Germany; Tropeninstitut Berlin, Berlin, Germany; Hôpital Cantonal, Geneva, Switzerland; Hôpital Pitié-Salpêtrière, Paris, France; Department of Tropical Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Novartis Pharma AG, Basel, Switzerland; Travel Clinic, Medical Outpatient Clinic, Lausanne, Switzerland

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The efficacy and safety of artemether-lumefantrine for the treatment of malaria in nonimmune populations are not well defined. In this study, 165 nonimmune patients from Europe and non-malarious areas of Colombia with acute, uncomplicated falciparum malaria or mixed infection including P. falciparum were treated with the six-dose regimen of artemether-lumefantrine. The parasitologic cure rate at 28 days was 96.0% for the per protocol population (119/124 patients). Median times to parasite clearance and fever clearance were 41.5 and 36.8 hours, respectively. No patient had gametocytes after Day 7. Treatment was well tolerated; most adverse events were mild to moderate and seemed to be related to malaria. There were few serious adverse events, none of which were considered to be drug-related. No significant effects on ECG or laboratory parameters were observed. In conclusion, the six-dose regimen of artemether-lumefantrine was effective and well tolerated in the treatment of acute uncomplicated falciparum malaria in nonimmune patients.

Author Notes

Reprint requests: Christoph Hatz, Swiss Tropical Institute, Socinstrasse 57, 4002 Basel, Switzerland. E-mail: christoph.hatz@unibas.ch.
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