MSPTM 2019 Annual Scientific Conference
13 - 14 March 2019
InterContinental Kuala Lumpur



The efficacy of dihydroartemisinin-piperaquine and artemether-lumefantrine against uncomplicated Plasmodium falciparum infections in adults and children in North Sumatera, Indonesia

Oral Presentation
Scaling Up Efforts in Tropical Disease and Vector Control through Evidence-Based Research


Main Author
Inke Nadia Diniyanti Lubis1
Presenting Author
Inke Nadia Diniyanti Lubis1
Hendri Wijaya1
Munar Lubis1
Chairuddin P Lubis1
Sarah G Staedke3
Colin J Sutherland2

Authors' Institution

Department / Institution / Country
Paediatrics / University of Sumatera Utara / Indonesia1
Immunology and Infection / London School of Hygiene and Tropical Medicine / United Kingdom2
Clinical Research / London School of Hygiene and Tropical Medicine / United Kingdom3
Abstract Content


Recent evidence of Plasmodium falciparum parasites with reduced susceptibility to artemisinin and its partner drugs in the Greater Mekong is a great concern for neighbouring countries including Indonesia. Indonesia has been using ACTs since 2004, started with the use of artesunate-amodiaquine and replaced by dihydroartemisinin-piperaquine in 2012. We enrolled 302 individuals in Batubara, Langkat and South Nias regencies between January and June 2015. Patients were randomised to receive a standard 3-dose of dihydroartemisinin-piperaquine (DHA-PQ) or 6-dose of artemether-lumefantrine (AL), and they were followed-up for 6 weeks. Polymorphisms in the drug resistance markers for P. falciparum were investigated. Most patients harboured genotypes pfcrt-SVMNT (88.8%, 63/71), pfmdr1-86Y/184Y (70.1%, 68/97) and pfk13-wild type alleles (88.0%, 66/75). Mutants pfk13 T474A and M476I were identified in 2 and 1 patients, respectively. The intention-to-treat analysis showed uncorrected efficacy of DHA-PQ and AL at day-42 were 84.0% and 90.4%, while the PCR-corrected efficacy for DHA-PQ and AL were 99.3% and 100%, respectively. Posthoc PCR determination of treatment failures isolates revealed poor specificity of microscopy and identified other infections with P. malariae, P. knowlesi, P. vivax, or a mixture of infection. Parasite clearance times estimated by qPCR for the first 72 hours after treatment revealed fast clearing, suggesting the parasites were sensitive to artemisinin. However, proportion of submicroscopic parasitaemia at the end of follow-up as determined by PCR were relatively high at 27.1% in DHA-PQ treatment arm and 27.8% in AL (P>0.05). Our conclusion is that artemisinin and its partner drugs maintain great sensitivity to Sumatran P. falciparum parasites; however submicroscopic infections of P. falciparum may persists in some individuals.

Keywords: Malaria; Plasmodium falciparum; ACTs; efficacy; Dihydroartemisinin-piperaquine; Artemether-lumefantrine; Indonesia
Requires Audio or Video system for Presentation?: No