03164nas a2200385   4500000000100000008004100001260004400042653005700086653002100143100001500164700001100179700001400190700001400204700001300218700001300231700001200244700001500256700001400271700001300285700001100298700001600309700001400325700002000339700001400359700001400373700002100387700001300408700001200421700001300433245014600446856005900592300000900651520209300660022002502753       2024                            d  bSpringer Science and Business Media LLC10aGeneral Biochemistry, Genetics and Molecular Biology10aGeneral Medicine1 aBottieau E1 aMbow M1 aBrosius I1 aRoucher C1 aGueye CT1 aMbodj OT1 aFaye BT1 aDe Hondt A1 aSmekens B1 aArango D1 aBurm C1 aTsoumanis A1 aParedis L1 aVan Herrewege Y1 aPotters I1 aRichter J1 aRosanas-Urgell A1 aCissé B1 aMboup S1 aPolman K00aAntimalarial artesunate–mefloquine versus praziquantel in African children with schistosomiasis: an open-label, randomized controlled trial  uhttps://www.nature.com/articles/s41591-023-02719-4.pdf  a1-143 a<p>Schistosomiasis treatment entirely relies on a single drug, praziquantel, prompting research into alternative therapeutics. Here we evaluated the efficacy and safety of the antimalarial combination artesunate–mefloquine for the treatment of schistosomiasis in a proof-of-concept, pragmatic, open-label, randomized controlled trial in primary schools of six villages endemic for schistosomiasis in northern Senegal. Children (6–14 years) were eligible if Schistosoma eggs were detected by microscopy in urine and/or stool. In total, 726 children were randomized 1:1 to praziquantel (standard care: 40 mg kg−1 single dose; n = 364) or to artesunate–mefloquine (antimalarial dosage: artesunate 4 mg kg−1 and mefloquine 8 mg kg−1 daily for three consecutive days; n = 362). Eight children not meeting the inclusion criteria were excluded from efficacy analysis. Median age of the remaining 718 participants was 9 years; 399 (55.6%) were male, and 319 (44.4%) female; 99.3% were infected with Schistosoma haematobium and 15.2% with S. mansoni. Primary outcomes were cure rate, assessed by microscopy, and frequency of drug-related adverse effects of artesunate–mefloquine versus praziquantel at 4 weeks after treatment. Cure rate was 59.6% (208/349) in the artesunate–mefloquine arm versus 62.1% (211/340) in the praziquantel arm. The difference of −2.5% (95% confidence interval (CI) −9.8 to 4.8) met the predefined criteria of noninferiority (margin set at 10%). All drug-related adverse events were mild or moderate, and reported in 28/361 children receiving artesunate–mefloquine (7.8%; 95% CI 5.4 to 11.0) versus 8/363 (2.2%; 95% CI 1.1 to 4.3) receiving praziquantel (P &lt; 0.001). Artesunate–mefloquine at antimalarial dosage was moderately safe and noninferior to standard-care praziquantel for the treatment of schistosomiasis, predominantly due to S. haematobium. Multicentric trials in different populations and epidemiological settings are needed to confirm these findings. ClinicalTrials.gov identifier: NCT03893097.</p>
  a1078-8956, 1546-170X