Therapeutic response to dihydroartemisinin-piperaquine for P. falciparum and P. Vivax nine years after its introduction in southern Papua, Indonesia

Abstract

Dihydroartemisinin-piperaquine (DHP) has been the first-line treatment of uncomplicated malaria due to both <i>Plasmodium falciparum</i> and <i>Plasmodium vivax</i> infections in Papua, Indonesia, since March 2006. The efficacy of DHP was reassessed to determine whether there had been any decline following almost a decade of its extensive use. An open-label drug efficacy study of DHP for uncomplicated <i>P. falciparum</i> and <i>P. vivax</i> malaria was carried out between March 2015 and April 2016 in Timika, Papua, Indonesia. Patients with uncomplicated malaria were administered supervised DHP tablets once daily for 3 days. Clinical and laboratory data were collected daily until parasite clearance and then weekly for 6 weeks. Molecular analysis was undertaken for all patients with recurrent parasitemia. A total of 129 study patients were enrolled in the study. At day 42, the polymerase chain reaction-adjusted efficacy was 97.7% (95% confidence intervals [CI]: 87.4-99.9) in the 61 patients with <i>P. falciparum</i> malaria, and 98.2% [95% CI: 90.3-100] in the 56 patients with <i>P. vivax</i> malaria. By day 2, 98% (56/57) of patients with <i>P. falciparum</i> and 96.9% (63/65) of those with <i>P. vivax</i> had cleared their peripheral parasitemia; none of the patients were still parasitaemic on day 3. Molecular analysis of <i>P. falciparum</i> parasites showed that none (0/61) had K13 mutations associated previously with artemisinin resistance or increased copy number of <i>plasmepsin</i> 2-3 (0/61). In the absence of artemisinin resistance, DHP has retained high efficacy for the treatment of uncomplicated malaria despite extensive drug pressure over a 9-year period.

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