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  1. Mamadou Tekete1,
  2. Juergen Burhenne2,
  3. Bakary Fofana1,
  4. Sekou Toure1,
  5. Souleymane Dama1,
  6. Nianwalou Dara1,
  7. Oumar Traore1,
  8. Bouran Sidibe1,
  9. Abdoulaye Djimde1,
  10. Walter Haefeli2,
  11. Steffen Borrmann3
  1. 1MRTC, University of Bamako, Mali
  2. 2Heidelberg University, Germany
  3. 3ITM Tübingen, Germany


Background Since 2006 the national malaria control program in Mali recommended artemether-lumefantrine (AL) as the first-line treatment of uncomplicated malaria. The role of lumefantrine in this combination is to eliminate remaining parasites after the action of artemether and to protect the patient against a new blood infection. Some studies showed a correlation between lumefantrine's day 7 concentration and the efficacy of AL after treatment of a single episode of malaria. The objective of this work is to validate this observation after repetitive treatment of uncomplicated malaria patients with AL.

Methods During a phase IIIb/IV comparative, randomised, multicentre, clinical study of artemisinin-based combination therapies, we collected plasma on Day 7 from patients treated with standard dose of AL in Sotuba, Bougoula Hameau, and Kolle (Mali). The age of the patients enrolled in this study was from 6 months old. The plasma samples were kept at – 80°C until lumefantrine analysis using high performance liquid chromatography was performed.

Results We included 1076 subjects, of which 595 were females and a mean age of 12 years old in this analysis.

The median concentration was 66% higher (p<0.0001) in patients without recurrent parasite on day 28 compared to patients with recurrent parasitaemia: 509.1 ng/ml (inter quartile range: 329.6–723.2; n=919) vs 372.5 (255.7–538.4; n=157). Day 7 concentrations increased with age; the difference between age group was statistically significant: 305.9 (207.3–491.5, n=140), 447 (290.7–622.9, n=399), 544.7 (383.9–738.5, n=254) and 571.1 (378.8–850.9), n=283) in patients under 5 years old, 5–9 years old, 10–14 years old and 15 years old and older, respectively. Girls under 5 years old had a lower lumefantrine concentration at day 7 compared to other age groups of 223.3 ng/ml (159.7–425.6, n=37).

Conclusions We found a lower concentration of lumefantrine in patients with recurrent parasitaemia at day 28.

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