Randomized, Prospective, Three-Arm Study to Confirm the Auditory Safety and Efficacy of Artemether-Lumefantrine in Colombian Patients with Uncomplicated Plasmodium falciparum Malaria

Gabriel Carrasquilla Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Clemencia Barón Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Edwin M. Monsell Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Marc Cousin Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Verena Walter Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Gilbert Lefèvre Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Oliver Sander Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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Laurel M. Fisher Fundación Santa Fe de Bogotá, Bogotá, Colombia; Wayne State University, Detroit, Michigan; Novartis Pharma AG, Basel, Switzerland; House Ear Institute (HEI), Los Angeles, California

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The safety of artemether-lumefantrine in patients with acute, uncomplicated Plasmodium falciparum malaria was investigated prospectively using the auditory brainstem response (ABR) and pure-tone thresholds. Secondary outcomes included polymerase chain reaction-corrected cure rates. Patients were randomly assigned in a 3:1:1 ratio to either artemether-lumefantrine (N = 159), atovaquone-proguanil (N = 53), or artesunate-mefloquine (N = 53). The null hypothesis (primary outcome), claiming that the percentage of patients with a baseline to Day-7 ABR Wave III latency increase of > 0.30 msec is ≥ 15% after administration of artemether-lumefantrine, was rejected; 2.6% of patients (95% confidence interval: 0.7–6.6) exceeded 0.30 msec, i.e., significantly below 15% (P < 0.0001). A model-based analysis found no apparent relationship between drug exposure and ABR change. In all three groups, average improvements (2–4 dB) in pure-tone thresholds were observed, and polymerase chain reaction-corrected cure rates were > 95% to Day 42. The results support the continued safe and efficacious use of artemether-lumefantrine in uncomplicated falciparum malaria.

Author Notes

*Address correspondence to Gabriel Carrasquilla, Centro de Estudios e Investigación en Salud-CEIS, Fundación Santa Fe de Bogotá, Carrera 7B No. 123-90, Bogotá, DC, Colombia. E-mail: Gabriel.Carrasquilla@fsfb.org.co

Financial support: This study was supported by Novartis Pharma Ltd., Basel, Switzerland.

Disclosure: Marc Cousin, Verena Walter, Gilbert Lefèvre, and Oliver Sander are employees of Novartis Pharma Ltd.

Authors' addresses: Gabriel Carrasquilla and Clemencia Barón, Centro de Estudios e Investigación en Salud-CEIS, Fundación Santa Fe de Bogotá, Bogotá, DC, Colombia, E-mails: Gabriel.Carrasquilla@fsfb.org.co and cbaron@cable.net.co. Edwin M. Monsell, Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, E-mail: emonsell@med.wayne.edu. Marc Cousin, Established Medicines DF/Tropical Medicines, Novartis Pharma AG, Basel, Switzerland, E-mail: marc.cousin@novartis.com. Verena Walter, Integrated Information Sciences, Novartis Pharma AG, Basel, Switzerland, E-mail: verena.walter@novartis.com. Gilbert Lefèvre, Translational Sciences, Novartis Pharma AG, Basel, Switzerland, E-mail: gilbert.lefevre@novartis.com. Oliver Sander, Modeling and Simulation, CHBS, Novartis Pharma AG, Basel, Switzerland, E-mail: oliver.sander@novartis.com. Laurel M. Fisher, House Ear Institute (HEI), Los Angeles, CA, E-mail: lfisher@hei.org.

Reprint requests: Gabriel Carrasquilla, Centro de Estudios e Investigación en Salud-CEIS, Fundación Santa Fe de Bogotá, Carrera 7B No. 123-90, Bogotá, DC, Colombia.

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