World Health Organization, 2014. World Malaria Report 2014. Geneva, Switzerland: World Health Organization.
Souza JM, 1986. Mefloquine clinical trials—therapeutical experience with mefloquine alone and combination (MSP) in Brazilian male subjects with falciparum malaria. Mem Inst Oswaldo Cruz 81 (Suppl II): 259–268.
Ministry of Health of Brazil, 2001. Manual de Terapêutica da Malária. Brasília, Brazil: Ministry of Health of Brazil. Available at: http://portal.saude.gov.br/portal/arquivos/pdf/manu_terapeutica_malaria.pdf.
Cerutti C Jr, Durlacher RR, de Alencar FE, Segurado AA, Pang LW, 1999. In vivo efficacy of mefloquine for the treatment of falciparum malaria in Brazil. J Infect Dis 180: 2077–2080.
Duarte EC, Fontes CJ, Gyorkos TW, Abrahamowicz M, 1996. Randomized controlled trial of artesunate plus tetracycline versus standard treatment (quinine plus tetracycline) for uncomplicated Plasmodium falciparum malaria in Brazil. Am J Trop Med Hyg 54: 197–202.
de Alencar FE, Cerutti C Jr, Durlacher RR, Boulos M, Alves FP, Milhous W, Pang LW, 1997. Atovaquone and proguanil for the treatment of malaria in Brazil. J Infect Dis 175: 1544–1547.
Zalis MG, Pang L, Silveira MS, Milhous WK, Wirth DF, 1998. Characterization of Plasmodium falciparum isolated from the Amazon region of Brazil: evidence for quinine resistance. Am J Trop Med Hyg 58: 630–637.
Pratt-Riccio LR, Chehuan YF, Siqueira MJ, das Graças Alecrim M, Bianco-Junior C, Druilhe P, Brasseur P, de Fátima Ferreira-da-Cruz M, Carvalho LJ, Daniel-Ribeiro CT, 2013. Use of a colorimetric (DELI) test for the evaluation of chemoresistance of Plasmodium falciparum and Plasmodium vivax to commonly used anti-plasmodial drugs in the Brazilian Amazon. Malar J 12: 281.
Wells S, Diap G, Kiechel JR, 2013. The story of artesunate-mefloquine (ASMQ), innovative partnerships in drug development: case study. Malar J 12: 68.
Santelli AC, Ribeiro I, Daher A, Boulos M, Marchesini PB, dos Santos RL, Lucena MB, Magalhães I, Leon AP, Junger W, Ladislau JL, 2012. Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in Amazon basin communities. Malar J 11: 286.
Pan American Health Organization, 1998. Evaluación de la Eficacia Terapéutica de los Medicamentos para el Tratamiento del Paludismo por Plasmodium falciparum sin Complicaciones en las Américas. Washington, DC: Pan American Health Organization.
de Oliveira AM, Chavez J, de Leon GP, Durand S, Arrospide N, Roberts J, Cabezas C, Marquiño W, 2011. Efficacy and effectiveness of mefloquine and artesunate combination therapy for uncomplicated Plasmodium falciparum malaria in the Peruvian Amazon. Am J Trop Med Hyg 85: 573–578.
Ministry of Health of Brazil, 2010. Guia Prático de Tratamento da Malária no Brasil. Brasília, Brazil: Ministry of Health of Brazil. Available at: http://bvsms.saude.gov.br/bvs/publicacoes/guia_pratico_malaria.pdf.
Kimura M, Kaneko O, Liu Q, Zhou M, Kawamoto F, Wataya Y, Otanie S, Yamaguchi Y, Tanabe K, 1997. Identification of the four species of human malaria parasites by nested PCR that targets variant sequences in the small subunit rRNA gene. Parasitol Int 46: 91–95.
World Health Organization, 2003. Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated Falciparum Malaria. Geneva, Switzerland: World Health Organization.
Newcombe R, 1998. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17: 857–872.
Price RN, Uhlemann AC, Brockman A, McGready R, Ashley E, Phaipun L, Patel R, Laing K, Looareesuwan S, White NJ, Nosten F, Krishna S, 2004. Mefloquine resistance in Plasmodium falciparum and increased pfmdr1 gene copy number. Lancet 364: 438–447.
Ariey F, Witkowski B, Amaratunga C, Beghain J, Langlois AC, Khim N, Kim S, Duru V, Bouchier C, Ma L, Lim P, Leang R, Duong S, Sreng S, Suon S, Chuor CM, Bout DM, Ménard S, Rogers WO, Genton B, Fandeur T, Miotto O, Ringwald P, Le Bras J, Berry A, Barale JC, Fairhurst RM, Benoit-Vical F, Mercereau-Puijalon O, Ménard D, 2014. A molecular marker of artemisinin-resistant Plasmodium falciparum malaria. Nature 505: 50–55.
Mita T, Tachibana SI, Hashimoto M, Hirai M, 2016. Plasmodium falciparum kelch 13: a potential molecular marker for tackling artemisinin-resistant malaria parasites. Expert Rev Anti Infect Ther 14: 125–135.
Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, Sreng S, Anderson JM, Mao S, Sam B, Sopha C, Chuor CM, Nguon C, Sovannaroth S, Pukrittayakamee S, Jittamala P, Chotivanich K, Chutasmit K, Suchatsoonthorn C, Runcharoen R, Hien TT, Thuy-Nhien NT, Thanh NV, Phu NH, Htut Y, Han KT, Aye KH, Mokuolu OA, Olaosebikan RR, Folaranmi OO, Mayxay M, Khanthavong M, Hongvanthong B, Newton PN, Onyamboko MA, Fanello CI, Tshefu AK, Mishra N, Valecha N, Phyo AP, Nosten F, Yi P, Tripura R, Borrmann S, Bashraheil M, Peshu J, Faiz MA, Ghose A, Hossain MA, Samad R, Rahman MR, Hasan MM, Islam A, Miotto O, Amato R, MacInnis B, Stalker J, Kwiatkowski DP, Bozdech Z, Jeeyapant A, Cheah PY, Sakulthaew T, Chalk J, Intharabut B, Silamut K, Lee SJ, Vihokhern B, Kunasol C, Imwong M, Tarning J, Taylor WJ, Yeung S, Woodrow CJ, Flegg JA, Das D, Smith J, Venkatesan M, Plowe CV, Stepniewska K, Guerin PJ, Dondorp AM, Day NP, White NJ, Tracking Resistance to Artemisinin Collaboration (TRAC), 2014. Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 371: 411–423.
White NJ, 2011. The parasite clearance curve. Malar J 10: 278.
White NJ, Ashley EA, Recht J, Delves MJ, Ruecker A, Smithuis FM, Eziefula AC, Bousema T, Drakeley C, Chotivanich K, Imwong M, Pukrittayakamee S, Prachumsri J, Chu C, Andolina C, Bancone G, Hien TT, Mayxay M, Taylor WR, von Seidlein L, Price RN, Barnes KI, Djimdé A, ter Kuile F, Gosling R, Chen I, Dhorda MJ, Stepniewska K, Guérin P, Woodrow CJ, Dondorp AM, Day NP, Nosten FH, 2014. Assessment of therapeutic responses to gametocytocidal drugs in Plasmodium falciparum malaria. Malar J 13: 483.
Beshir KB, Sutherland CJ, Sawa P, Drakeley CJ, Okell L, Mweresa CK, Omar SA, Shekalaghe SA, Kaur H, Ndaro A, Chilongola J, Schallig HD, Sauerwein RW, Hallett RL, Bousema T, 2013. Residual Plasmodium falciparum parasitemia in Kenyan children after artemisinin-combination therapy is associated with increased transmission to mosquitoes and parasite recurrence. J Infect Dis 208: 2017–2024.
Miotto O, Amato R, Ashley EA, MacInnis B, Almagro-Garcia J, Amaratunga C, Lim P, Mead D, Oyola SO, Dhorda M, Imwong M, Woodrow C, Manske M, Stalker J, Drury E, Campino S, Amenga-Etego L, Thanh TN, Tran HT, Ringwald P, Bethell D, Nosten F, Phyo AP, Pukrittayakamee S, Chotivanich K, Chuor CM, Nguon C, Suon S, Sreng S, Newton PN, Mayxay M, Khanthavong M, Hongvanthong B, Htut Y, Han KT, Kyaw MP, Faiz MA, Fanello CI, Onyamboko M, Mokuolu OA, Jacob CG, Takala-Harrison S, Plowe CV, Day NP, Dondorp AM, Spencer CC, McVean G, Fairhurst RM, White NJ, Kwiatkowski DP, 2015. Genetic architecture of artemisinin-resistant Plasmodium falciparum. Nat Genet 47: 226–234.
da Silva-Nunes M, Ferreira MU, 2007. Clinical spectrum of uncomplicated malaria in semi-immune Amazonians: beyond the “symptomatic” vs “asymptomatic” dichotomy. Mem Inst Oswaldo Cruz 102: 341–347.
Marquino W, Huilca M, Calampa C, Falconi E, Cabezas C, Naupay R, Ruebush TK 2nd, 2003. Efficacy of mefloquine and a mefloquine-artesunate combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon basin of Peru. Am J Trop Med Hyg 68: 608–612.
Gutman J, Green M, Durand S, Rojas OV, Ganguly B, Quezada WM, Utz GC, Slutsker L, Ruebush TK 2nd, Bacon DJ, 2009. Mefloquine pharmacokinetics and mefloquine-artesunate effectiveness in Peruvian patients with uncomplicated Plasmodium falciparum malaria. Malar J 8: 58.
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We evaluated the clinical efficacy of artesunate–mefloquine (ASMQ) fixed-dose combination to treat uncomplicated malaria in Juruá Valley, the main Plasmodium falciparum transmission hotspot in Brazil. Between November 2010 and February 2013, we enrolled 162 patients aged 4–73 years, with fever or a history of fever, and a single-species P. falciparum infection confirmed by microscopy and polymerase chain reaction (PCR). All 154 patients who completed the 42-day follow-up presented an adequate clinical and parasitologic response. ASMQ was well tolerated and no adverse event caused treatment interruption. Gametocytes were detected in 46.3% patients; 35.2% had gametocytes at enrollment, whereas others developed patent gametocytemia 1–14 days after starting ASMQ. By day 3 of treatment, all subjects had cleared asexual parasitemia, but parasite DNA remained PCR detectable in 37.6% of them. Day-3 PCR positivity was associated with prolonged gametocyte carriage. We found no molecular evidence of resistance to either MQ (pfmdr1 gene amplification) or AS (mutations in selected kelch13 gene domains known to be associated with AS resistance) in the local P. falciparum population. These results strongly support the use of ASMQ as a first-line regimen to treat uncomplicated P. falciparum malaria in northwestern Brazil, but underscore the need for gametocytocidal drugs to reduce the transmission potential of ASMQ-treated patients (ClinicalTrials.gov number NCT01144702).
Financial support: This clinical study was supported by the Amazonian Malaria Initiative (AMI)/Amazon Network for the Surveillance of Antimalarial Drug Resistance (RAVREDA) through the Pan American Health Organization (PAHO; BR/LOA/0900212.001), Ministry of Health of Brazil, and Oswaldo Cruz Foundation (cooperation agreements 25380.4120/09-26 and 82/2012). AMI is a partnership of the U.S. Agency for International Development with PAHO, Centers for Disease Control and Prevention (CDC), the Management Sciences for Health's Rational Pharmaceutical Management Plus (MSH/RPM Plus) program, the U.S. Pharmacopoeia, and Links Media, Inc. RAVREDA was organized in 2001 by several countries with PAHO's support to respond to the challenge of antimalarial drug resistance in the Amazon. Laboratory work was partially supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil (grant 404067/2012-3). Laís C. Salla, Priscila T. Rodrigues, and Marcelo U. Ferreira are supported by CNPq scholarships.
Authors' addresses: Simone Ladeia-Andrade, Laboratory of Parasitic Diseases, Oswaldo Cruz Institute/Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil and Amazonian Malaria Initiative/Amazon Network for the Surveillance of Antimalarial Drug Resistance, Regional Hospital of Juruá Valley, Cruzeiro do Sul, Brazil, E-mail: shawam@uol.com.br. Gladson Naber P. de Melo and Rita de Cássia de Souza-Lima, Amazonian Malaria Initiative/Amazon Network for the Surveillance of Antimalarial Drug Resistance, Regional Hospital of Juruá Valley, Cruzeiro do Sul, Brazil, E-mails: gladson_melo@hotmail.com and draritalima@yahoo.com.br. Laís C. Salla, Melissa S. Bastos, Priscila T. Rodrigues, and Marcelo U. Ferreira, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil, E-mails: lais.salla@usp.br, melissabastos@yahoo.com.br, priscilathihara@usp.br, and muferrei@usp.br. Francisco das Chagas O. Luz, Center for Tropical Medicine, Campus Universitário Darcy Ribeiro, University of Brasília, Brasília, Brazil, E-mail: franciluz@yahoo.com.br.
World Health Organization, 2014. World Malaria Report 2014. Geneva, Switzerland: World Health Organization.
Souza JM, 1986. Mefloquine clinical trials—therapeutical experience with mefloquine alone and combination (MSP) in Brazilian male subjects with falciparum malaria. Mem Inst Oswaldo Cruz 81 (Suppl II): 259–268.
Ministry of Health of Brazil, 2001. Manual de Terapêutica da Malária. Brasília, Brazil: Ministry of Health of Brazil. Available at: http://portal.saude.gov.br/portal/arquivos/pdf/manu_terapeutica_malaria.pdf.
Cerutti C Jr, Durlacher RR, de Alencar FE, Segurado AA, Pang LW, 1999. In vivo efficacy of mefloquine for the treatment of falciparum malaria in Brazil. J Infect Dis 180: 2077–2080.
Duarte EC, Fontes CJ, Gyorkos TW, Abrahamowicz M, 1996. Randomized controlled trial of artesunate plus tetracycline versus standard treatment (quinine plus tetracycline) for uncomplicated Plasmodium falciparum malaria in Brazil. Am J Trop Med Hyg 54: 197–202.
de Alencar FE, Cerutti C Jr, Durlacher RR, Boulos M, Alves FP, Milhous W, Pang LW, 1997. Atovaquone and proguanil for the treatment of malaria in Brazil. J Infect Dis 175: 1544–1547.
Zalis MG, Pang L, Silveira MS, Milhous WK, Wirth DF, 1998. Characterization of Plasmodium falciparum isolated from the Amazon region of Brazil: evidence for quinine resistance. Am J Trop Med Hyg 58: 630–637.
Pratt-Riccio LR, Chehuan YF, Siqueira MJ, das Graças Alecrim M, Bianco-Junior C, Druilhe P, Brasseur P, de Fátima Ferreira-da-Cruz M, Carvalho LJ, Daniel-Ribeiro CT, 2013. Use of a colorimetric (DELI) test for the evaluation of chemoresistance of Plasmodium falciparum and Plasmodium vivax to commonly used anti-plasmodial drugs in the Brazilian Amazon. Malar J 12: 281.
Wells S, Diap G, Kiechel JR, 2013. The story of artesunate-mefloquine (ASMQ), innovative partnerships in drug development: case study. Malar J 12: 68.
Santelli AC, Ribeiro I, Daher A, Boulos M, Marchesini PB, dos Santos RL, Lucena MB, Magalhães I, Leon AP, Junger W, Ladislau JL, 2012. Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in Amazon basin communities. Malar J 11: 286.
Pan American Health Organization, 1998. Evaluación de la Eficacia Terapéutica de los Medicamentos para el Tratamiento del Paludismo por Plasmodium falciparum sin Complicaciones en las Américas. Washington, DC: Pan American Health Organization.
de Oliveira AM, Chavez J, de Leon GP, Durand S, Arrospide N, Roberts J, Cabezas C, Marquiño W, 2011. Efficacy and effectiveness of mefloquine and artesunate combination therapy for uncomplicated Plasmodium falciparum malaria in the Peruvian Amazon. Am J Trop Med Hyg 85: 573–578.
Ministry of Health of Brazil, 2010. Guia Prático de Tratamento da Malária no Brasil. Brasília, Brazil: Ministry of Health of Brazil. Available at: http://bvsms.saude.gov.br/bvs/publicacoes/guia_pratico_malaria.pdf.
Kimura M, Kaneko O, Liu Q, Zhou M, Kawamoto F, Wataya Y, Otanie S, Yamaguchi Y, Tanabe K, 1997. Identification of the four species of human malaria parasites by nested PCR that targets variant sequences in the small subunit rRNA gene. Parasitol Int 46: 91–95.
World Health Organization, 2003. Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated Falciparum Malaria. Geneva, Switzerland: World Health Organization.
Newcombe R, 1998. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17: 857–872.
Price RN, Uhlemann AC, Brockman A, McGready R, Ashley E, Phaipun L, Patel R, Laing K, Looareesuwan S, White NJ, Nosten F, Krishna S, 2004. Mefloquine resistance in Plasmodium falciparum and increased pfmdr1 gene copy number. Lancet 364: 438–447.
Ariey F, Witkowski B, Amaratunga C, Beghain J, Langlois AC, Khim N, Kim S, Duru V, Bouchier C, Ma L, Lim P, Leang R, Duong S, Sreng S, Suon S, Chuor CM, Bout DM, Ménard S, Rogers WO, Genton B, Fandeur T, Miotto O, Ringwald P, Le Bras J, Berry A, Barale JC, Fairhurst RM, Benoit-Vical F, Mercereau-Puijalon O, Ménard D, 2014. A molecular marker of artemisinin-resistant Plasmodium falciparum malaria. Nature 505: 50–55.
Mita T, Tachibana SI, Hashimoto M, Hirai M, 2016. Plasmodium falciparum kelch 13: a potential molecular marker for tackling artemisinin-resistant malaria parasites. Expert Rev Anti Infect Ther 14: 125–135.
Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, Sreng S, Anderson JM, Mao S, Sam B, Sopha C, Chuor CM, Nguon C, Sovannaroth S, Pukrittayakamee S, Jittamala P, Chotivanich K, Chutasmit K, Suchatsoonthorn C, Runcharoen R, Hien TT, Thuy-Nhien NT, Thanh NV, Phu NH, Htut Y, Han KT, Aye KH, Mokuolu OA, Olaosebikan RR, Folaranmi OO, Mayxay M, Khanthavong M, Hongvanthong B, Newton PN, Onyamboko MA, Fanello CI, Tshefu AK, Mishra N, Valecha N, Phyo AP, Nosten F, Yi P, Tripura R, Borrmann S, Bashraheil M, Peshu J, Faiz MA, Ghose A, Hossain MA, Samad R, Rahman MR, Hasan MM, Islam A, Miotto O, Amato R, MacInnis B, Stalker J, Kwiatkowski DP, Bozdech Z, Jeeyapant A, Cheah PY, Sakulthaew T, Chalk J, Intharabut B, Silamut K, Lee SJ, Vihokhern B, Kunasol C, Imwong M, Tarning J, Taylor WJ, Yeung S, Woodrow CJ, Flegg JA, Das D, Smith J, Venkatesan M, Plowe CV, Stepniewska K, Guerin PJ, Dondorp AM, Day NP, White NJ, Tracking Resistance to Artemisinin Collaboration (TRAC), 2014. Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 371: 411–423.
White NJ, 2011. The parasite clearance curve. Malar J 10: 278.
White NJ, Ashley EA, Recht J, Delves MJ, Ruecker A, Smithuis FM, Eziefula AC, Bousema T, Drakeley C, Chotivanich K, Imwong M, Pukrittayakamee S, Prachumsri J, Chu C, Andolina C, Bancone G, Hien TT, Mayxay M, Taylor WR, von Seidlein L, Price RN, Barnes KI, Djimdé A, ter Kuile F, Gosling R, Chen I, Dhorda MJ, Stepniewska K, Guérin P, Woodrow CJ, Dondorp AM, Day NP, Nosten FH, 2014. Assessment of therapeutic responses to gametocytocidal drugs in Plasmodium falciparum malaria. Malar J 13: 483.
Beshir KB, Sutherland CJ, Sawa P, Drakeley CJ, Okell L, Mweresa CK, Omar SA, Shekalaghe SA, Kaur H, Ndaro A, Chilongola J, Schallig HD, Sauerwein RW, Hallett RL, Bousema T, 2013. Residual Plasmodium falciparum parasitemia in Kenyan children after artemisinin-combination therapy is associated with increased transmission to mosquitoes and parasite recurrence. J Infect Dis 208: 2017–2024.
Miotto O, Amato R, Ashley EA, MacInnis B, Almagro-Garcia J, Amaratunga C, Lim P, Mead D, Oyola SO, Dhorda M, Imwong M, Woodrow C, Manske M, Stalker J, Drury E, Campino S, Amenga-Etego L, Thanh TN, Tran HT, Ringwald P, Bethell D, Nosten F, Phyo AP, Pukrittayakamee S, Chotivanich K, Chuor CM, Nguon C, Suon S, Sreng S, Newton PN, Mayxay M, Khanthavong M, Hongvanthong B, Htut Y, Han KT, Kyaw MP, Faiz MA, Fanello CI, Onyamboko M, Mokuolu OA, Jacob CG, Takala-Harrison S, Plowe CV, Day NP, Dondorp AM, Spencer CC, McVean G, Fairhurst RM, White NJ, Kwiatkowski DP, 2015. Genetic architecture of artemisinin-resistant Plasmodium falciparum. Nat Genet 47: 226–234.
da Silva-Nunes M, Ferreira MU, 2007. Clinical spectrum of uncomplicated malaria in semi-immune Amazonians: beyond the “symptomatic” vs “asymptomatic” dichotomy. Mem Inst Oswaldo Cruz 102: 341–347.
Marquino W, Huilca M, Calampa C, Falconi E, Cabezas C, Naupay R, Ruebush TK 2nd, 2003. Efficacy of mefloquine and a mefloquine-artesunate combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon basin of Peru. Am J Trop Med Hyg 68: 608–612.
Gutman J, Green M, Durand S, Rojas OV, Ganguly B, Quezada WM, Utz GC, Slutsker L, Ruebush TK 2nd, Bacon DJ, 2009. Mefloquine pharmacokinetics and mefloquine-artesunate effectiveness in Peruvian patients with uncomplicated Plasmodium falciparum malaria. Malar J 8: 58.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 29 | 29 | 8 |
Full Text Views | 333 | 103 | 0 |
PDF Downloads | 93 | 24 | 0 |