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Efficacy of dihydroartemisinin/piperaquine in patients with noncomplicated Plasmodium falciparum malaria in Yaoundé, Cameroon

Abstract : Background: Dihydroartemisinin/piperaquine is increasingly used for the treatment of uncomplicated Plasmodium falciparum malaria in Africa. The efficacy of this combination in Cameroon is poorly documented, while resistance to dihydroartemisinin/piperaquine readily spreads in Southeast Asia. Objectives: This study evaluated the clinical efficacy of dihydroartemisinin/piperaquine in Cameroon, as well as the molecular profile and phenotypic susceptibility of collected isolates to dihydroartemisinin and piperaquine. Patients and methods: Dihydroartemisinin/piperaquine efficacy in 42 days was followed-up for 138 patients presenting non-complicated falciparum malaria. Piperaquine concentration was determined at day 7 for 124 patients. kelch13 gene polymorphisms (n = 150) and plasmepsin2 gene amplification (n = 148) were determined as molecular markers of resistance to dihydroartemisinin and piperaquine, respectively. Parasite susceptibility to dihydroartemisinin and piperaquine was determined using validated in vitro survival assays. Results: The efficacy of dihydroartemisinin/piperaquine treatment was 100% after PCR correction. The reinfections were not associated with a variation of piperaquine concentration at day 7. Ninety-six percent (144/150) of the samples presented a WT allele of the kelch13 gene. Two percent (3/150) presented the non-synonymous mutation A578S, which is not associated with resistance to dihydroartemisinin. No duplication of the plasmep-sin2 gene was observed (0/148). All the samples tested in vitro by survival assays (n = 87) were susceptible to dihydroartemisinin and piperaquine. Conclusions: Dihydroartemisinin/piperaquine has demonstrated excellent therapeutic efficacy with no evidence of emerging artemisinin or piperaquine resistance in Yaoundé, Cameroon. This observation suggests that dihydroartemisinin/piperaquine could be a sustainable therapeutic solution for P. falciparum malaria if implemented in areas previously free of artemisinin-and piperaquine-resistant parasites, unlike Southeast Asia.
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Submitted on : Monday, December 20, 2021 - 3:22:39 AM
Last modification on : Monday, January 17, 2022 - 10:06:04 AM

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Mélissa Mairet-Khedim, Sandrine Nsango, Christelle Ngou, Sandie Menard, Camille Roesch, et al.. Efficacy of dihydroartemisinin/piperaquine in patients with noncomplicated Plasmodium falciparum malaria in Yaoundé, Cameroon. Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), 2021, 76 (11), pp.3037-3044. ⟨10.1093/jac/dkab281⟩. ⟨pasteur-03494748⟩

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