Lumefantrine plasma concentrations in uncontrolled conditions among patients treated with artemether-lumefantrine for uncomplicated plasmodium falciparum malaria in Mwanza, Tanzania.

Abstract

BACKGROUND:

Therapeutic efficacy of artemether-lumefantrine is highly dependent on adequate systemic exposure to the partner drug lumefantrine particularly day 7 lumefantrine plasma concentration. There has been contradicting findings on the role of the cut-off values in predicting treatment outcomes among malaria patients in malaria endemic regions. This study assesses the day 3 and 7 lumefantrine plasma concentrations including related determinant factors and their influence on treatment outcomes among treated Tanzanian children and adults in uncontrolled conditions (real life condition).

METHODS:

Data was nested from an efficacy study employing the WHO protocol, 2015 for monitoring antimalarial drug efficacy. Lumefantrine plasma concentration was measured by high performance liquid chromatography with ultraviolet (HPLC-UV).

RESULTS:

Lumefantrine plasma concentrations below 175ng/ml and 200ng/ml on day 3 and 7 did not affect adequate clinical and parasitological response (ACPR) and recurrence of infection (p = 0.428 and 0.239 respectively). Age and baseline parasitemia were not associated to day 3 median lumefantrine plasma concentrations (p = 0.08 and 0.31 respectively) and day 7 lumefantrine plasma concentrations (p = 0.07 and 0.41 respectively). However, the day 3 and day 7 lumefantrine plasma concentrations were significantly higher in males compared to females (p = 0.03 and 0.042 respectively).

CONCLUSION:

Lumefantrine plasma concentrations below cut-off points (175ng/ml and 200ng/ml) on day 3 and 7 did not influence treatment outcomes.

• Authors: Karol J Marwa, Anthony C Liwa, Eveline T Konje, Stanley Mwita, Erasmus Kamugisha, Göte Swedberg
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 123 Pg. 192-199 (Oct 2022) ISSN: 1878-3511 [Electronic] Canada
• PMID: 36064162 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Antimalarials
• Artemether, Lumefantrine Drug Combination
• Artemisinins
• Drug Combinations
• Ethanolamines
• Fluorenes
• Artemether
• Lumefantrine

Topics

• Adult
• Antimalarials (therapeutic use)
• Artemether (therapeutic use)
• Artemether, Lumefantrine Drug Combination (therapeutic use)
• Artemisinins (therapeutic use)
• Child
• Drug Combinations
• Ethanolamines (therapeutic use)
• Female
• Fluorenes (therapeutic use)
• Humans
• Lumefantrine (therapeutic use)
• Malaria (drug therapy)
• Malaria, Falciparum (drug therapy)
• Male
• Plasmodium falciparum
• Tanzania
• Treatment Outcome