TY - JOUR
T1 - Drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon
T2 - a systematic review and meta-analysis (1998-2020)
AU - Niba, Peter Thelma Ngwa
AU - Nji, Akindeh M
AU - Evehe, Marie-Solange
AU - Ali, Innocent M
AU - Netongo, Palmer Masumbe
AU - Ngwafor, Randolph
AU - Moyeh, Marcel N
AU - Ngum, Lesley Ngum
AU - Ndum, Oliva Ebie
AU - Acho, Fon Abongwa
AU - Mbu'u, Cyrille Mbanwi
AU - Fosah, Dorothy A
AU - Atogho-Tiedeu, Barbara
AU - Achonduh-Atijegbe, Olivia
AU - Djokam-Dadjeu, Rosine
AU - Chedjou, Jean Paul Kengne
AU - Bigoga, Jude D
AU - Moukoko, Carole Else Eboumbou
AU - Ajua, Anthony
AU - Achidi, Eric
AU - Tallah, Esther
AU - Leke, Rose G F
AU - Tourgordi, Alexis
AU - Ringwald, Pascal
AU - Alifrangis, Michael
AU - Mbacham, Wilfred F
PY - 2021/1/9
Y1 - 2021/1/9
N2 - BACKGROUND: Malaria remains highly endemic in Cameroon. The rapid emergence and spread of drug resistance was responsible for the change from monotherapies to artemisinin-based combinations. This systematic review and meta-analysis aimed to determine the prevalence and distribution of Plasmodium falciparum drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon from January 1998 to August 2020.METHODS: The PRISMA-P and PRISMA statements were adopted in the inclusion of studies on single nucleotide polymorphisms (SNPs) of P. falciparum anti-malarial drug resistance genes (Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, Pfatp6, Pfcytb and Pfk13). The heterogeneity of the included studies was evaluated using the Cochran's Q and I2 statistics. The random effects model was used as standard in the determination of heterogeneity between studies.RESULTS: Out of the 902 records screened, 48 studies were included in this aggregated meta-analysis of molecular data. A total of 18,706 SNPs of the anti-malarial drug resistance genes were genotyped from 47,382 samples which yielded a pooled prevalence of 35.4% (95% CI 29.1-42.3%). Between 1998 and 2020, there was significant decline (P < 0.0001 for all) in key mutants including Pfcrt 76 T (79.9%-43.0%), Pfmdr1 86Y (82.7%-30.5%), Pfdhfr 51I (72.2%-66.9%), Pfdhfr 59R (76.5%-67.8%), Pfdhfr 108 N (80.8%-67.6%). The only exception was Pfdhps 437G which increased over time (30.4%-46.9%, P < 0.0001) and Pfdhps 540E that remained largely unchanged (0.0%-0.4%, P = 0.201). Exploring mutant haplotypes, the study observed a significant increase in the prevalence of Pfcrt CVIET mixed quintuple haplotype from 57.1% in 1998 to 57.9% in 2020 (P < 0.0001). In addition, within the same study period, there was no significant change in the triple Pfdhfr IRN mutant haplotype (66.2% to 67.3%, P = 0.427). The Pfk13 amino acid polymorphisms associated with artemisinin resistance were not detected.CONCLUSIONS: This review reported an overall decline in the prevalence of P. falciparum gene mutations conferring resistance to 4-aminoquinolines and amino alcohols for a period over two decades. Resistance to artemisinins measured by the presence of SNPs in the Pfk13 gene does not seem to be a problem in Cameroon. Systematic review registration PROSPERO CRD42020162620.
AB - BACKGROUND: Malaria remains highly endemic in Cameroon. The rapid emergence and spread of drug resistance was responsible for the change from monotherapies to artemisinin-based combinations. This systematic review and meta-analysis aimed to determine the prevalence and distribution of Plasmodium falciparum drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon from January 1998 to August 2020.METHODS: The PRISMA-P and PRISMA statements were adopted in the inclusion of studies on single nucleotide polymorphisms (SNPs) of P. falciparum anti-malarial drug resistance genes (Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, Pfatp6, Pfcytb and Pfk13). The heterogeneity of the included studies was evaluated using the Cochran's Q and I2 statistics. The random effects model was used as standard in the determination of heterogeneity between studies.RESULTS: Out of the 902 records screened, 48 studies were included in this aggregated meta-analysis of molecular data. A total of 18,706 SNPs of the anti-malarial drug resistance genes were genotyped from 47,382 samples which yielded a pooled prevalence of 35.4% (95% CI 29.1-42.3%). Between 1998 and 2020, there was significant decline (P < 0.0001 for all) in key mutants including Pfcrt 76 T (79.9%-43.0%), Pfmdr1 86Y (82.7%-30.5%), Pfdhfr 51I (72.2%-66.9%), Pfdhfr 59R (76.5%-67.8%), Pfdhfr 108 N (80.8%-67.6%). The only exception was Pfdhps 437G which increased over time (30.4%-46.9%, P < 0.0001) and Pfdhps 540E that remained largely unchanged (0.0%-0.4%, P = 0.201). Exploring mutant haplotypes, the study observed a significant increase in the prevalence of Pfcrt CVIET mixed quintuple haplotype from 57.1% in 1998 to 57.9% in 2020 (P < 0.0001). In addition, within the same study period, there was no significant change in the triple Pfdhfr IRN mutant haplotype (66.2% to 67.3%, P = 0.427). The Pfk13 amino acid polymorphisms associated with artemisinin resistance were not detected.CONCLUSIONS: This review reported an overall decline in the prevalence of P. falciparum gene mutations conferring resistance to 4-aminoquinolines and amino alcohols for a period over two decades. Resistance to artemisinins measured by the presence of SNPs in the Pfk13 gene does not seem to be a problem in Cameroon. Systematic review registration PROSPERO CRD42020162620.
KW - Antimalarials/pharmacology
KW - Cameroon
KW - Drug Resistance/drug effects
KW - Genetic Markers/genetics
KW - Plasmodium falciparum/drug effects
KW - Polymorphism, Single Nucleotide
KW - Mutations
KW - Malaria
KW - Efficacy
KW - Systematic review
KW - Resistance
KW - Plasmodium falciparum
KW - Anti-malarial drug
UR - http://www.scopus.com/inward/record.url?scp=85098991638&partnerID=8YFLogxK
U2 - 10.1186/s12936-020-03543-8
DO - 10.1186/s12936-020-03543-8
M3 - Review
C2 - 33422080
SN - 1475-2875
VL - 20
SP - 32
JO - Malaria Journal
JF - Malaria Journal
IS - 1
M1 - 32
ER -