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In Vivo Assessment of Drug Efficacy against Plasmodium falciparum Malaria: Duration of Follow-Up. Kasia Stepniewska, 2004.To determine the optimum duration of follow-up for the assessment of drug efficacy against Plasmodium falciparum malaria, 96 trial arms from randomized controlled trials (RCTs) with follow-up of 28 days or longer that were conducted between 1990 and 2003 were analyzed . These trials enrolled 13,772 patients, and participating patients comprised 23% of all patients enrolled in RCTs over the past 40 years; 61 (64%) trial arms were conducted in areas where the rate of malaria transmission was low, and 58 (50%) trial arms were supported by parasite genotyping to distinguish true recrudescences from reinfections . The median overall failure rate reported was 10% (range, 0 to 47%) . The widely used day 14 assessment had a sensitivity of between 0 and 37% in identifying treatment failures and had no predictive value . Assessment at day 28 had a sensitivity of 66% overall (28 to 100% in individual trials) but could be used to predict the true failure rate if either parasite genotyping was performed (r2 = 0.94) or if the entomological inoculation rate was known . In the assessment of drug efficacy against falciparum malaria, 28 days should be the minimum period of follow-up .
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