Efficacy of artesunate with sulfalene plus pyrimethamine versus praziquantel for treatment of Schistosoma mansoni in Kenyan children: an open-label randomised controlled trial

• Published in: The Lancet infectious diseases 2010-09, Vol.10 (9), p.603-611
• Main Authors: Obonyo, Charles O, Dr, Muok, Erick MO, MSc, Mwinzi, Pauline NM, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Amebicides - adverse effects; Amebicides - therapeutic use; Animals; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiparasitic agents; Antiprotozoal Agents - adverse effects; Antiprotozoal Agents - therapeutic use; Artemisinins - adverse effects; Artemisinins - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Infectious Disease; Infectious diseases; Kenya; Male; Medical sciences; Pharmacology. Drug treatments; Pyrimethamine - adverse effects; Pyrimethamine - therapeutic use; Schistosoma mansoni; Schistosomiasis; Schistosomiasis mansoni - classification; Schistosomiasis mansoni - drug therapy; Sulfalene - adverse effects; Sulfalene - therapeutic use
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(10)70161-4

Summary Background Schistosomiasis is an important parasitic disease in Kenya. Decreasing susceptibility of schistosomes to praziquantel, the major drug used to reduce disease morbidity, has made assessment of new antischistosomal drugs a priority. We aimed to assess the safety and efficacy of an artesunate-based combination drug in the treatment of schistosomiasis. Methods In this open-label randomised trial in Rarieda district of western Kenya, we enrolled school children (aged 6–15 years) who had Schistosoma mansoni infection according to duplicate Kato-Katz thick smears from a stool sample. Computer-generated block randomisation was used to assign children (1:1) to receive artesunate (100 mg) with sulfalene (also known as sulfamethoxypyrazine; 250 mg) plus pyrimethamine (12·5 mg) as one dose every 24 h for 3 days or one dose of praziquantel (40 mg/kg per day). The primary efficacy endpoint was the number of participants cured 28 days after treatment. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov , number NCT01054651. Results Between October and December, 2009, 212 children were enrolled and assigned to receive artesunate with sulfalene plus pyrimethamine (n=106) or praziquantel (n=106). 69 patients (65%) were cured in the praziquantel treatment group compared with 15 (14%) in the artesunate with sulfalene plus pyrimethamine treatment group (p