Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya

Gladys C. Chemwor; Ben M. Andagalu; Irene A. Onyango; Benjamin H. Opot; Raphael O. Okoth; Redemptah A. Yedah; Jackline A. Juma; Edwin W. Mwakio; Dancan M. Wakoli; Joseph G. Amwoma; Agnes C. Cheruiyot; Dennis W. Juma; Bernhards R. Ogutu; Timothy E. Egbo; Eric C. Garges; Amanda L. Roth; Edwin Kamau; Oliver J. Watson; Hoseah M. Akala

doi:10.1016/j.ijid.2023.04.008

Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya

Gladys C. Chemwor, Ben M. Andagalu, Irene A. Onyango, Benjamin H. Opot, Raphael O. Okoth, Redemptah A. Yedah, Jackline A. Juma, Edwin W. Mwakio, Dancan M. Wakoli, Joseph G. Amwoma, Agnes C. Cheruiyot, Dennis W. Juma, Bernhards R. Ogutu, Timothy E. Egbo, Eric C. Garges, Amanda L. Roth, Edwin Kamau, Oliver J. Watson, Hoseah M. Akala^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Objectives: This study examined the treatment response of mixed vs single-species Plasmodium falciparum infections to artemisinin-based combination therapies (ACTs). Methods: A total of 1211 blood samples collected on days 0, 7, 14, 21, 28, 35, and 42 from 173 individuals enrolled in two randomized ACT efficacy studies were tested for malaria using 18s ribosomal RNA-based real-time polymerase chain reaction. All recurrent parasitemia were characterized for Plasmodium species composition and time to reinfection during 42-day follow-up compared across ACTs. Results: Day 0 samples had 71.1% (116/163) single P. falciparum infections and 28.2% (46/163) coinfections. A total of 54.0% (88/163) of individuals tested positive for Plasmodium at least once between days 7-42. A total of 19.3% (17/88) of individuals with recurrent infections were infected with a different Plasmodium species than observed at day 0, with 76.5% (13/17) of these “hidden” infections appearing after clearing P. falciparum present at day 0. Artesunate-mefloquine (16.4 hours) and dihydroartemisinin-piperaquine (17.6 hours) had increased clearance rates over artemether-lumefantrine (21.0 hours). Dihydroartemisinin-piperaquine exhibited the longest duration of reinfection prophylaxis. Cure rates were comparable across each species composition. Conclusion: No differences in clearance rates were found depending on whether the infection contained species other than P. falciparum. Significantly longer durations of protection were observed for individuals treated with dihydroartemisinin-piperaquine.

Original language	English
Pages (from-to)	17-25
Number of pages	9
Journal	International Journal of Infectious Diseases
Volume	132
DOIs	https://doi.org/10.1016/j.ijid.2023.04.008
State	Published - Jul 2023
Externally published	Yes

Keywords

Mixed-species infections
Non-falciparum
Plasmodium, falciparum
Therapeutic efficacy

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10.1016/j.ijid.2023.04.008

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Chemwor, G. C., Andagalu, B. M., Onyango, I. A., Opot, B. H., Okoth, R. O., Yedah, R. A., Juma, J. A., Mwakio, E. W., Wakoli, D. M., Amwoma, J. G., Cheruiyot, A. C., Juma, D. W., Ogutu, B. R., Egbo, T. E., Garges, E. C., Roth, A. L., Kamau, E., Watson, O. J., & Akala, H. M. (2023). Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya. International Journal of Infectious Diseases, 132, 17-25. https://doi.org/10.1016/j.ijid.2023.04.008

Chemwor, Gladys C. ; Andagalu, Ben M. ; Onyango, Irene A. et al. / Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections : a retrospective posthoc analysis in Kisumu County, western Kenya. In: International Journal of Infectious Diseases. 2023 ; Vol. 132. pp. 17-25.

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title = "Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya",

abstract = "Objectives: This study examined the treatment response of mixed vs single-species Plasmodium falciparum infections to artemisinin-based combination therapies (ACTs). Methods: A total of 1211 blood samples collected on days 0, 7, 14, 21, 28, 35, and 42 from 173 individuals enrolled in two randomized ACT efficacy studies were tested for malaria using 18s ribosomal RNA-based real-time polymerase chain reaction. All recurrent parasitemia were characterized for Plasmodium species composition and time to reinfection during 42-day follow-up compared across ACTs. Results: Day 0 samples had 71.1% (116/163) single P. falciparum infections and 28.2% (46/163) coinfections. A total of 54.0% (88/163) of individuals tested positive for Plasmodium at least once between days 7-42. A total of 19.3% (17/88) of individuals with recurrent infections were infected with a different Plasmodium species than observed at day 0, with 76.5% (13/17) of these “hidden” infections appearing after clearing P. falciparum present at day 0. Artesunate-mefloquine (16.4 hours) and dihydroartemisinin-piperaquine (17.6 hours) had increased clearance rates over artemether-lumefantrine (21.0 hours). Dihydroartemisinin-piperaquine exhibited the longest duration of reinfection prophylaxis. Cure rates were comparable across each species composition. Conclusion: No differences in clearance rates were found depending on whether the infection contained species other than P. falciparum. Significantly longer durations of protection were observed for individuals treated with dihydroartemisinin-piperaquine.",

keywords = "Mixed-species infections, Non-falciparum, Plasmodium, falciparum, Therapeutic efficacy",

author = "Chemwor, {Gladys C.} and Andagalu, {Ben M.} and Onyango, {Irene A.} and Opot, {Benjamin H.} and Okoth, {Raphael O.} and Yedah, {Redemptah A.} and Juma, {Jackline A.} and Mwakio, {Edwin W.} and Wakoli, {Dancan M.} and Amwoma, {Joseph G.} and Cheruiyot, {Agnes C.} and Juma, {Dennis W.} and Ogutu, {Bernhards R.} and Egbo, {Timothy E.} and Garges, {Eric C.} and Roth, {Amanda L.} and Edwin Kamau and Watson, {Oliver J.} and Akala, {Hoseah M.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2023",

month = jul,

doi = "10.1016/j.ijid.2023.04.008",

language = "English",

volume = "132",

pages = "17--25",

journal = "International Journal of Infectious Diseases",

issn = "1201-9712",

}

Chemwor, GC, Andagalu, BM, Onyango, IA, Opot, BH, Okoth, RO, Yedah, RA, Juma, JA, Mwakio, EW, Wakoli, DM, Amwoma, JG, Cheruiyot, AC, Juma, DW, Ogutu, BR, Egbo, TE, Garges, EC, Roth, AL, Kamau, E, Watson, OJ & Akala, HM 2023, 'Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya', International Journal of Infectious Diseases, vol. 132, pp. 17-25. https://doi.org/10.1016/j.ijid.2023.04.008

Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya. / Chemwor, Gladys C.; Andagalu, Ben M.; Onyango, Irene A. et al.
In: International Journal of Infectious Diseases, Vol. 132, 07.2023, p. 17-25.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections

T2 - a retrospective posthoc analysis in Kisumu County, western Kenya

AU - Chemwor, Gladys C.

AU - Andagalu, Ben M.

AU - Onyango, Irene A.

AU - Opot, Benjamin H.

AU - Okoth, Raphael O.

AU - Yedah, Redemptah A.

AU - Juma, Jackline A.

AU - Mwakio, Edwin W.

AU - Wakoli, Dancan M.

AU - Amwoma, Joseph G.

AU - Cheruiyot, Agnes C.

AU - Juma, Dennis W.

AU - Ogutu, Bernhards R.

AU - Egbo, Timothy E.

AU - Garges, Eric C.

AU - Roth, Amanda L.

AU - Kamau, Edwin

AU - Watson, Oliver J.

AU - Akala, Hoseah M.

PY - 2023/7

Y1 - 2023/7

N2 - Objectives: This study examined the treatment response of mixed vs single-species Plasmodium falciparum infections to artemisinin-based combination therapies (ACTs). Methods: A total of 1211 blood samples collected on days 0, 7, 14, 21, 28, 35, and 42 from 173 individuals enrolled in two randomized ACT efficacy studies were tested for malaria using 18s ribosomal RNA-based real-time polymerase chain reaction. All recurrent parasitemia were characterized for Plasmodium species composition and time to reinfection during 42-day follow-up compared across ACTs. Results: Day 0 samples had 71.1% (116/163) single P. falciparum infections and 28.2% (46/163) coinfections. A total of 54.0% (88/163) of individuals tested positive for Plasmodium at least once between days 7-42. A total of 19.3% (17/88) of individuals with recurrent infections were infected with a different Plasmodium species than observed at day 0, with 76.5% (13/17) of these “hidden” infections appearing after clearing P. falciparum present at day 0. Artesunate-mefloquine (16.4 hours) and dihydroartemisinin-piperaquine (17.6 hours) had increased clearance rates over artemether-lumefantrine (21.0 hours). Dihydroartemisinin-piperaquine exhibited the longest duration of reinfection prophylaxis. Cure rates were comparable across each species composition. Conclusion: No differences in clearance rates were found depending on whether the infection contained species other than P. falciparum. Significantly longer durations of protection were observed for individuals treated with dihydroartemisinin-piperaquine.

AB - Objectives: This study examined the treatment response of mixed vs single-species Plasmodium falciparum infections to artemisinin-based combination therapies (ACTs). Methods: A total of 1211 blood samples collected on days 0, 7, 14, 21, 28, 35, and 42 from 173 individuals enrolled in two randomized ACT efficacy studies were tested for malaria using 18s ribosomal RNA-based real-time polymerase chain reaction. All recurrent parasitemia were characterized for Plasmodium species composition and time to reinfection during 42-day follow-up compared across ACTs. Results: Day 0 samples had 71.1% (116/163) single P. falciparum infections and 28.2% (46/163) coinfections. A total of 54.0% (88/163) of individuals tested positive for Plasmodium at least once between days 7-42. A total of 19.3% (17/88) of individuals with recurrent infections were infected with a different Plasmodium species than observed at day 0, with 76.5% (13/17) of these “hidden” infections appearing after clearing P. falciparum present at day 0. Artesunate-mefloquine (16.4 hours) and dihydroartemisinin-piperaquine (17.6 hours) had increased clearance rates over artemether-lumefantrine (21.0 hours). Dihydroartemisinin-piperaquine exhibited the longest duration of reinfection prophylaxis. Cure rates were comparable across each species composition. Conclusion: No differences in clearance rates were found depending on whether the infection contained species other than P. falciparum. Significantly longer durations of protection were observed for individuals treated with dihydroartemisinin-piperaquine.

KW - Mixed-species infections

KW - Non-falciparum

KW - Plasmodium, falciparum

KW - Therapeutic efficacy

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U2 - 10.1016/j.ijid.2023.04.008

DO - 10.1016/j.ijid.2023.04.008

M3 - Article

C2 - 37061211

AN - SCOPUS:85153595565

SN - 1201-9712

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JO - International Journal of Infectious Diseases

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Chemwor GC, Andagalu BM, Onyango IA, Opot BH, Okoth RO, Yedah RA et al. Therapeutic response to artemisinin combination therapies among individuals with Plasmodium falciparum single infection vs mixed Plasmodium species infections: a retrospective posthoc analysis in Kisumu County, western Kenya. International Journal of Infectious Diseases. 2023 Jul;132:17-25. doi: 10.1016/j.ijid.2023.04.008