Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies
Abstract Background In Myanmar, three types of artemisinin-based combination therapy (ACT) are recommended as first-line treatment of uncomplicated falciparum malaria: artemether–lumefantrine (AL), artesunate–mefloquine (AS + MQ), and dihydroartemisinin–piperaquine (DP). Resistance to both artemisin...
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ftdoajarticles:oai:doaj.org/article:77c23769372741c591821d9c537562e3 2023-05-15T15:18:28+02:00 Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies Moe Kyaw Myint Charlotte Rasmussen Aung Thi Dorina Bustos Pascal Ringwald Khin Lin 2017-04-01T00:00:00Z https://doi.org/10.1186/s12936-017-1775-2 https://doaj.org/article/77c23769372741c591821d9c537562e3 EN eng BMC http://link.springer.com/article/10.1186/s12936-017-1775-2 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-1775-2 1475-2875 https://doaj.org/article/77c23769372741c591821d9c537562e3 Malaria Journal, Vol 16, Iss 1, Pp 1-10 (2017) Myanmar Treatment efficacy Plasmodium falciparum Molecular markers k13 Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2017 ftdoajarticles https://doi.org/10.1186/s12936-017-1775-2 2022-12-31T03:40:44Z Abstract Background In Myanmar, three types of artemisinin-based combination therapy (ACT) are recommended as first-line treatment of uncomplicated falciparum malaria: artemether–lumefantrine (AL), artesunate–mefloquine (AS + MQ), and dihydroartemisinin–piperaquine (DP). Resistance to both artemisinins and ACT partner drugs has been reported from the Greater Mekong Sub-region, and regular efficacy monitoring of the recommended ACT is conducted in Myanmar. This paper reports on results from studies to monitor the efficacy of the three forms of ACT in sentinel sites in northern Myanmar, and investigations of mutations in the Kelch13 (k13) propeller domain. Methods Seven therapeutic efficacy studies were conducted in 2011–12 and 2014 in three sentinel sites in Myanmar (Tamu, Muse, Tabeikkyin). Three studies were done for the evaluation of AL (204 patients), two studies for AS + MQ (119 patients) and two studies for DP (147 patients). These studies were done according to 2009 standard WHO protocol. Polymorphisms in the k13 propeller domain were examined in dried blood spots collected on day 0. The primary endpoint was adequate clinical and parasitological response (ACPR) on day 28 for AL and on day 42 for DP and AS + MQ, corrected to exclude re-infection using polymerase chain reaction (PCR) genotyping. Safety data were collected through self-reporting. Results PCR-corrected ACPR was 97.2–100% for AL, 98.6–100% for AS + MQ and 100% for DP across the study sites and years. All studies found a prevalence of k13 mutations (>440) above 23% in the day-0 samples. The F446I mutation was the most common mutation, making up 66.0% of the mutations found. Seven out of nine day-3 positive patients were infected with k13 wild type parasites. The remaining two cases with day-3 parasitaemia had the P574L mutation. Conclusions The efficacy of AL, AS + MQ and DP remains high in northern Myanmar despite widespread evidence of k13 mutations associated with delayed parasite clearance. This study showed that already in 2012 there was ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 16 1 |
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Myanmar Treatment efficacy Plasmodium falciparum Molecular markers k13 Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
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Myanmar Treatment efficacy Plasmodium falciparum Molecular markers k13 Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Moe Kyaw Myint Charlotte Rasmussen Aung Thi Dorina Bustos Pascal Ringwald Khin Lin Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies |
topic_facet |
Myanmar Treatment efficacy Plasmodium falciparum Molecular markers k13 Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background In Myanmar, three types of artemisinin-based combination therapy (ACT) are recommended as first-line treatment of uncomplicated falciparum malaria: artemether–lumefantrine (AL), artesunate–mefloquine (AS + MQ), and dihydroartemisinin–piperaquine (DP). Resistance to both artemisinins and ACT partner drugs has been reported from the Greater Mekong Sub-region, and regular efficacy monitoring of the recommended ACT is conducted in Myanmar. This paper reports on results from studies to monitor the efficacy of the three forms of ACT in sentinel sites in northern Myanmar, and investigations of mutations in the Kelch13 (k13) propeller domain. Methods Seven therapeutic efficacy studies were conducted in 2011–12 and 2014 in three sentinel sites in Myanmar (Tamu, Muse, Tabeikkyin). Three studies were done for the evaluation of AL (204 patients), two studies for AS + MQ (119 patients) and two studies for DP (147 patients). These studies were done according to 2009 standard WHO protocol. Polymorphisms in the k13 propeller domain were examined in dried blood spots collected on day 0. The primary endpoint was adequate clinical and parasitological response (ACPR) on day 28 for AL and on day 42 for DP and AS + MQ, corrected to exclude re-infection using polymerase chain reaction (PCR) genotyping. Safety data were collected through self-reporting. Results PCR-corrected ACPR was 97.2–100% for AL, 98.6–100% for AS + MQ and 100% for DP across the study sites and years. All studies found a prevalence of k13 mutations (>440) above 23% in the day-0 samples. The F446I mutation was the most common mutation, making up 66.0% of the mutations found. Seven out of nine day-3 positive patients were infected with k13 wild type parasites. The remaining two cases with day-3 parasitaemia had the P574L mutation. Conclusions The efficacy of AL, AS + MQ and DP remains high in northern Myanmar despite widespread evidence of k13 mutations associated with delayed parasite clearance. This study showed that already in 2012 there was ... |
format |
Article in Journal/Newspaper |
author |
Moe Kyaw Myint Charlotte Rasmussen Aung Thi Dorina Bustos Pascal Ringwald Khin Lin |
author_facet |
Moe Kyaw Myint Charlotte Rasmussen Aung Thi Dorina Bustos Pascal Ringwald Khin Lin |
author_sort |
Moe Kyaw Myint |
title |
Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies |
title_short |
Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies |
title_full |
Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies |
title_fullStr |
Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies |
title_full_unstemmed |
Therapeutic efficacy and artemisinin resistance in northern Myanmar: evidence from in vivo and molecular marker studies |
title_sort |
therapeutic efficacy and artemisinin resistance in northern myanmar: evidence from in vivo and molecular marker studies |
publisher |
BMC |
publishDate |
2017 |
url |
https://doi.org/10.1186/s12936-017-1775-2 https://doaj.org/article/77c23769372741c591821d9c537562e3 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 16, Iss 1, Pp 1-10 (2017) |
op_relation |
http://link.springer.com/article/10.1186/s12936-017-1775-2 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-1775-2 1475-2875 https://doaj.org/article/77c23769372741c591821d9c537562e3 |
op_doi |
https://doi.org/10.1186/s12936-017-1775-2 |
container_title |
Malaria Journal |
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16 |
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1 |
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1766348662640738304 |