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Table 2 Analysis of contribution of in vitro parasite sensitivity and systemic drug exposure during acute phase of infection and relationship with pfmdr1 copy number in patients with sensitive response following treatment with a three-day artesunate (AS)-mefloquine (MQ) combination regimen

From: Identification of resistance of Plasmodium falciparum to artesunate-mefloquine combination in an area along the Thai-Myanmar border: integration of clinico-parasitological response, systemic drug exposure, and in vitro parasite sensitivity

Drug concentrations

Case No.

Parasite slope half-life (h)a

In vitro sensitivity (IC50, nM)b

Pfmdr1 copy number

MQ AUC0-7d/ DHA AUC0-24h/

Conclusion on parasite sensitivity and adequacy of systemic drung exposure

   

AS

MQ

   

Adequate DHA exposure alone (n= 4)

18

2.90

Reduced (2.4±1.0)

Resistant (34.5±3.2)

>1

8.40c

-Possible AS resistant

-MQ resistant + Inadequate MQ exposure

19

2.97

Sensitive (1.1±0.15)

Sensitive (8.0±1.4)

1

6.78c

-AS sensitive

-MQ sensitive + Inadequate MQ exposure

-Predicted by pfmdr1 copy number

20

3.01

Sensitive (2.0±0.25)

Resistant (31.3±1.6)

1

7.77c

- AS sensitive

- MQ resistant + Inadequate MQ exposure

-Predicted by pfmdr1 copy number

21

2.78

Sensitive (1.8±0.13)

Sensitive (17.5±3.0)

1

7.09c

-AS sensitive

- MQ sensitive + Inadequate MQ exposure

-Predicted by pfmdr1 copy number

Adequate MQ exposure alone (n=9)

22

3.11

Reduced (3.2±0.15)

Resistant (90.0±16.5)

1

402d

-Possible AS resistant + Inadequate DHA exposure

-MQ resistant

-Predicted by pfmdr1 copy number

23

3.23

Sensitive (0.4±0.04)

Sensitive (14.6±2.2)

1

389d

-AS sensitive + Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number

24

2.78

Sensitive (0.3±0.10)

Sensitive (13.7±2.4)

1

390d

-AS sensitive+ Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number

25

3.01

Sensitive (1.8±0.31)

Resistant (47.5±1.7)

>1

391d

-AS sensitive + Inadequate DHA exposure

-MQ resistant

26

2.89

Sensitive (1.6±0.30)

Sensitive (20.9±0.5)

1

398d

-AS sensitive+ Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number entration

27

2.77

Sensitive (1.6±0.24)

Resistant (27.1±1.0)

1

450d

-Possible AS resistant + Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number

28

3.01

Sensitive (1.9±0.35)

Sensitive (18.5±2.4)

1

409d

-AS sensitive + Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number

29

2.89

Sensitive (1.0±0.03)

Sensitive (8.1±0.1)

1

379d

-AS sensitive + Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number

30

3.01

Sensitive (2.2±0.16)

Sensitive (19.1±1.0)

1

423d

-AS sensitive + Inadequate DHA exposure

-MQ sensitive

-Predicted by pfmdr1 copy number

Adequate DHA and MQ exposure (n=6)

31

2.67

Reduced (3.4±0.44)

Resistant (100.7±16.8)

>1

-

-Possible AS resistant

-MQ resistant

32

2.89

Reduced (3.8±0.62)

Resistant (62.2±4.6)

>1

-

-Possible AS resistant

-MQ resistant

33

3.00

Reduced (3.3±0.37)

Resistant (60.0±4.2)

>1

-

-Possible AS resistant

-MQ resistant

34

3.00

Sensitive (1.4±0.31)

Sensitive (6.8±0.5)

1

-

-AS sensitive

-MQ sensitive

-Predicted by pfmdr1 copy number

35

2.09

Sensitive (0.9±0.13)

Resistant (25.1±0.2)

1

-

-AS sensitive

-MQ resistant

-Predicted by pfmdr1 copy number

36

2.89

Sensitive (1.6±0.19)

Sensitive (21.2±0.3)

1

-

-AS sensitive

-MQ sensitive

-Predicted by pfmdr1 copy number

Inadequate DHA and MQ exposure (n=2)

37

2.90

Sensitive (1.5±0.23)

Sensitive (14.3±2.7)

>1

5.34c

-AS sensitive

234d

-MQ sensitive

38

3.01

Sensitive (1.9±0.28)

Sensitive (22.1±0.4)

1

7.09c

-AS sensitive

209d

-MQ sensitive

       

-Predicted by pfmdr1 copy number

  1. a Delayed parasite slope half-life if > 2.99 h.
  2. b Mean ± SD of 3 experiments, triplicate each.
  3. c MQ AUC 0-7d which was lower than the lower limit of 95% CI (8.48 μg.day/ml).
  4. d DHA AUC 0-24h which was lower than the lower limit of 95% CI (8.48 ng.h/ml).