The online version of this article (doi:10.1186/1475-2875-11-233) contains supplementary material, which is available to authorized users.
Nicola Gargano, Silva Tommasini, Antonella Bacchieri and Marco Corsi were from Sigma-Tau developing the product. None of the other authors has any conflict of interest.
NG, ST, AB, and MC: Development and manufacturing of drug, DU: Manuscript preparation and overall coordination of study, PCB, BHK and ND: Medical supervision and patient care during clinical trial at Down town, Wenlock Government District and Goa Medical College hospitals respectively, VD, SKG and AK enrolment of patients, follow up and coordination at respective study sites, BS: parasitological assessment and quality assurance, NV: Overall coordination, protocol development, review and editing of manuscript. All authors read and approved the final manuscript.
Resistance in Plasmodium falciparum to commonly used anti-malarial drugs, especially chloroquine, is being increasingly documented in India. By 2007, the first-line treatment for uncomplicated malaria has been revised to recommend artemisinin-based combination therapy (ACT) for all confirmed P. falciparum cases.
The objective of this study was to compare the efficacy, safety and tolerability between dihydroartemisinin-piperaquine (DP) and artesunate plus mefloquine (A + M) drug combinations in the treatment of uncomplicated P. falciparum malaria in India.
Between 2006 and 2007, 150 patients with acute uncomplicated P. falciparum malaria were enrolled, randomized to DP (101) or A + M (49) and followed up for 63 days as part of an open-label, non-inferiority, randomized, phase III multicenter trial in Asia.
The heterogeneity analysis showed no statistically significant difference between India and the other countries involved in the phase III study, for both the PCR-corrected and uncorrected cure rates. As shown at the whole study level, both forms of ACT were highly efficacious in India. In fact, in the per protocol population, the 63-day cure rates were 100% for A + M and 98.8% for DP. The DP combination exerted a significant post-treatment prophylactic effect, and compared with A + M a significant reduction in the incidence of new infections for DP was observed (respectively 17.1% versus 7.5% of patients experienced new infection within follow up). Parasite and fever clearance was rapid in both treatment arms (median time to parasite clearance of one day for both groups). Both DP and A + M were well tolerated, with the majority of adverse events of mild or moderate severity. The frequencies of individual adverse events were generally similar between treatments, although the incidence of post treatment adverse events was slightly higher in patients who received A + M with respect to those treated with DP.
DP is a new ACT displaying high efficacy and safety in the treatment of uncomplicated P. falciparum malaria and could potentially be considered for the first-line treatment of uncomplicated falciparum malaria in India.
Current Controlled Trials ISRCTN 81306618
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- Therapeutic efficacy and safety of dihydroartemisinin-piperaquine versus artesunate-mefloquine in uncomplicated Plasmodium falciparum malaria in India
Prabhash C Bhattacharyya
Bappanad HK Rao
Susanta K Ghosh
- BioMed Central
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