%0 Journal Article
%T Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: a multi-centre analysis
%A Julien Zwang
%A Piero Olliaro
%A Hubert Barennes
%A Maryline Bonnet
%A Philippe Brasseur
%A Hasifa Bukirwa
%A Sandra Cohuet
%A Umberto D'Alessandro
%A Abdulaye Djimd¨¦
%A Corine Karema
%A Jean-Paul Guthmann
%A Sally Hamour
%A Jean-Louis Ndiaye
%A Andreas M£¿rtensson
%A Claude Rwagacondo
%A Issaka Sagara
%A Albert Same-Ekobo
%A Sodiomon B Sirima
%A Ingrid van den Broek
%A Adoke Yeka
%A Walter RJ Taylor
%A Grant Dorsey
%A Milijaona Randrianarivelojosia
%J Malaria Journal
%D 2009
%I BioMed Central
%R 10.1186/1475-2875-8-203
%X An individual patient data (IPD) analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints.A total of 11,700 patients (75% under 5 years old), from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700). AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897) were included in randomized comparative trials with polymerase chain reaction (PCR) genotyping results and compared to 5,413 patients (half receiving an ACT).AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off) in 11/16 countries. In randomized comparative trials (n = 22), the crude efficacy of AS&AQ was 75.9% (95% CI 74.6¨C77.1) and the PCR-adjusted efficacy was 93.9% (95% CI 93.2¨C94.5). The risk (weighted by site) of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site), and not different from AS+SP or AL (artemether-lumefantrine). The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons). Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery.AS&AQ compares well to other treatments and meets the WHO efficacy criteria for use against falciparum malaria in many, but not all, the sub-Saharan African countries where it was studied. Efficacy varies between and within countries. An IPD analysis can inform general and local treatment policies. Ongoing monitoring evaluation is required.Artemisinin-based combination therapy (ACT) is now the treatment of choice for uncompl
%U http://www.malariajournal.com/content/8/1/203