Efficacy of artemisinin derivatives and kelch13 mutations in Plasmodium falciparum: a systematic review and meta-analysis.
Özlem Ulusan Bağcı, Atilla Halil Elhan, Gülay Aral Akarsu
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In 30 seconds
This systematic review and meta-analysis assessed ACT efficacy and the distribution of pfk13 mutations in studies of uncomplicated Plasmodium falciparum malaria across Asia, Africa, and the Americas. Thirty studies reporting 28-day adequate clinical and parasitological response (ACPR) and mutation status were included. Pooled ACPR rates exceeded 95%, with no significant regional differences (P = .99), while pfk13 mutation prevalence was significantly higher in Asia (P = .001). High treatment success persisted despite increasing mutation prevalence, suggesting that molecular markers and clinical outcomes do not have a simple relationship.
Key findings
- Across the included studies, pooled 28-day ACPR rates with ACTs exceeded 95%.
- ACPR showed no significant regional differences (P = .99).
- Prevalence of pfk13 mutations was significantly higher in Asia (P = .001).
- High treatment success was maintained despite increasing prevalence of pfk13 mutations.
Why it matters
The findings show that pfk13 mutation prevalence alone may not reflect observed ACT treatment success. Partner-drug efficacy, host immunity, and local transmission dynamics may also shape clinical outcomes. Considering molecular surveillance alongside therapeutic efficacy monitoring can help interpret resistance signals and track whether high response rates persist across regions.
What to keep in mind
The review included only studies reporting 28-day ACPR alongside pfk13 mutation assessment, so its findings may not represent studies lacking both measures.