%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Abdulla, S.
%A Adam, I.
%A Adjei, G. O.
%A Adjuik, M. A.
%A Alemayehu, B.
%A Allan, R.
%A Arinaitwe, E.
%A Ashley, E. A.
%A Ba, M. S.
%A Barennes, H.
%A Barnes, K. I.
%A Bassat, Q.
%A Baudin, E.
%A Berens-Riha, N.
%A Bjorkman, A.
%A Bompart, F.
%A Bonnet, M.
%A Borrmann, S.
%A Bousema, T.
%A Brasseur, Philippe
%A Bukirwa, H.
%A Checchi, F.
%A Dahal, P.
%A D'Alessandro, U.
%A Desai, M.
%A Dicko, A.
%A Djimde, A. A.
%A Dorsey, G.
%A Doumbo, O. K.
%A Drakeley, C. J.
%A Duparc, S.
%A Eshetu, T.
%A Espie, E.
%A Etard, Jean-François
%A et al.
%T Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria : a literature review and meta-analysis of individual patient data
%D 2015
%L fdi:010065266
%G ENG
%J Bmc Medicine
%@ 1741-7015
%K AFRIQUE SUBSAHARIENNE
%M ISI:000360804700001
%P art. 212 [16 ]
%R 10.1186/s12916-015-0445-x
%U https://www.documentation.ird.fr/hor/fdi:010065266
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-10/010065266.pdf
%V 13
%W Horizon (IRD)
%X Background: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). Methods: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. Results: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 degrees C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). Conclusions: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.
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