Table 2 Effects of artemether-lumefantrine versus dihydroartemisinin-piperaquine on gametocyte carriage/clearance
From: A review of the effects of artemether-lumefantrine on gametocyte carriage and disease transmission
Reference | Study description (location) | Study population | Gametocyte diagnostic method | Key conclusions |
|---|---|---|---|---|
Kakuru et al.[12] | Open-label randomized controlled trial (AL vs DP + TS prophylaxis) in Tororo district, Uganda | 351 children (aged ≥4 months) | Microscopy | Rate of gametocyte clearance was more than 2-fold greater with AL than DP (HR 2.20; p < 0.001) |
100 HIV-unexposed | ||||
203 HIV-exposed | ||||
48 HIV-infected | ||||
Sawa et al. [26] | Randomized, open label trial (AL vs DP) in Mbita, Western Kenya Use of QT-NASBA and mosquito feeding assays | 298 children (aged 6Â months to 10Â years) | QT-NASBA, feeding assays | AL was associated with a significantly shorter duration of gametocyte carriage, and a significantly shorter time to gametocyte clearance than DP |
Malaria transmission to mosquitoes was significantly lower after AL treatment than after DP | ||||
Smithuis et al.[32] | Open-label randomized trial (comparison of ACT, including DP vs AL) in Myanmar | >800 adults and children | Microscopy | Gametocyte carriage was variable following treatment with different ACT, although all rates were higher with DP than other ACT regimens, including AL |
Zwang et al.[44] | Analysis of 7 open-label randomized comparative studies (DP vs AL and vs other ACT) in Northwest Thailand, Rakhine state, Myanmar, Southern Laos, and Western Cambodia | 3,547 adults and children | Microscopy | Clearance of gametocytaemia was slower in DP groups than in the comparators, overall and in individual sites |
Yeka et al.[50] | Randomized study (AL vs DP) in Western Uganda (area of moderate transmission) | 408 children (aged 6Â months to 10Â years) | Microscopy | Patients treated with DP had a lower risk of developing gametocytaemia than those treated with AL after therapy |
Mens et al.[52] | Randomized study (AL vs DP) in Mbita, Western Kenya, use of QT-NASBA | 146 children | Microscopy | A more rapid reduction in gametocytes was observed with AL than with DP |
QT-NASBA | ||||
QT-NASBA provides a far more sensitive method than microscopy in gametocyte detection | ||||
Kamya et al.[57] | Randomized single-blinded study (AL vs DP) in Apac, District, Uganda (area of high transmission) | 417 children (aged 6Â months to 10Â years) | Microscopy | Patients treated with DP had a lower risk of recurrent parasitaemia due to non-falciparum species, and development of gametocytaemia compared with patients treated with AL |