This study examined reports of treatment failure with artemether-lumefantrine (A-L) for malaria in Abuja, Nigeria from 2017-2019. Over 170 people prescribed A-L reported treatment failure, regardless of age, brand, or formulation. A study of 5820 participants found that 87.61% did not improve after A-L treatment, while only 10.39% had an excellent outcome. The study concluded that resistance to A-L has emerged, likely due to evasion of its mechanism of action. However, treatment successes were seen with an A-L gel formulation. Further studies are recommended to establish A-L resistance and examine pharmacokinetic differences between formulations.

1. Emergence of Resistance to
Artemether-Lumefantrine in the
Treatment of Malaria in Abuja
Nigeria
By
Dr . Sa'ad Ado Koki

2. Background
• This is a longitudinal study that was carried a Community Pharmacy in
Abuja Nigeria. The study ran from November 2017 to September
2019
• The result of the study was corroborated by reports from the reports
gotten from numerous Community Pharmacies and clinical settings
like hospitals and clinics within Abuja municipal and suburbs
• Not less than 170 persons who were prescribed Artemether-
Lumefantrine (A-L) to between November 2017 and January
2018, reported treatment failure
• In many cases, the combination treatment was recommended by
Pharmacists

3. Background: Con't
• The study tried to find out the reason behind the treatment failure
with A-L
• Note that the treatment failure cut across all brands of A-L and
generics; hence, it was not brand specific. The treatment failure was
noted to be equal in all age groups including children under 5,
adolescents, adults (both men and women) and elderly. It was also
noted to cut across all formulations off A-L : dispersible, suspensions
and tablets( except gel, which the study has not yet concluded on)

4. Introduction
• A-L is an artemesinin based combination therapy of malaria.
• It is one of the most popular malarial treatment in environments that
are malaria endemic.
• It is available on prescription and as an over-the counter (OTC)
• The dosing regimen is 3 days with twice dosing frequency.
• It is claimed that fatty medium increases the rate of absorption of the
drug
• Apart from few medical conditions or medication history that could
pose contraindication, A-L is widely tolerated.

5. Methodology
• A total of 5820 participants were recruited for the study across all age
group irrespective of dosage form taken
• For children and adolescents, consent was taken from parents or
guardians.
• Exclusion criterion was pregnancy and taking malarial medicine other
that A-L
• Follow-up was made to ensure compliance to the instruction on
phone or physical presence of the participants.
• Outcomes were documented
• Statistical analysis was conducted at the end of the study

6. Results
• Within the period in focus, 87.61% of the participants reported lack of
improvement post treatment.
• 10.39% of the participants excellent outcome post treatment with A-L
• 2% did not show nor returned calls or messages to know their
outcomes

7. Conclusion
• Emergence of resistance no some of the newer antimalarial medicines has
been reported for so long. As the reports of resistance to A-L started
trickling, believe in the efficacy of a injectable monotherapy with Arteether
is increasing. Both are not a good story. The failure of A-L was witnessed in
both uncomplicated and complicated malaria tested positive in the lab for
P. falciparum.
• It is suspected that the suspected resistance is as theresult of evading a
rate limiting step in the mechanism of action pathway of A-L. This
conclusion was decided on because the participants were made sure that
they complied with the regimen accordngly . The 8-hour interval between
first and second dose was emphasized and compliance recorded. Hence,
the justification for suspecting resistance.
• On the contrary, treatment successes were recorded with a gel dosage
form of A-L

8. Recommendation
• It is recommended to conduct further studies to establish the
emergence of resistance to A-L
• Absence of resistance to those who took gel form A-L indicated that
there is more to unravel of A-L in terms of Pharmacokinetic profiles.
• There is need to document all about treatment with A-L in clinical
settings as this particular study was principally community-based
study

9. •Thank you