Abstract
Introduction
Despite advances in clinical care, therapeutic strategies, and governmental interventions, malaria remains a significant public health concern—particularly in Africa, which consistently ranks highest in global morbidity and mortality reports from the World Health Organization. In the Democratic Republic of the Congo (DRC), malaria is one of the leading causes of medical consultations. This is largely due to the ineffectiveness of some antimalarial medications, which are often of substandard quality, contributing to therapeutic failures and the emergence of drug-resistant Plasmodium strains. Artemisinin derivatives are the mainstay of antimalarial therapy, with artemether–lumefantrine being the most commonly used oral formulation.
Purpose
This study aimed to evaluate the in vitro dissolution profiles of various artemether–lumefantrine brands available on the Congolese pharmaceutical market.
Methods
Fourteen brands of artemether–lumefantrine tablets at 80/480 mg and two at 20/120 mg dosage strengths were subjected to pharmaceutical quality control tests, including mass uniformity, friability, and disintegration. Qualitative and quantitative analyses were performed using high-performance liquid chromatography with diode-array detection (HPLC-DAD). Dissolution testing was conducted in 0.005 M HCl with 2% Myrj 52 at pH 1.2. Comparative dissolution profiles were assessed using similarity (f₂) and difference (f₁) factors.
Results
All samples complied with pharmaco-technical standards and demonstrated dissolution profiles comparable to the reference formulation (f₁ < 15; f₂ ≥ 50).
Conclusion
The artemether–lumefantrine generics available on the Kinshasa market exhibit similar in vitro dissolution characteristics to the reference product, supporting their potential interchangeability.
References
Africa Check. (2024). 30 to 60 % des médicaments consommés en Afrique sont-ils des contrefaçons ? Consulté le 31 décembre 2024, to l’adresse https://africacheck.org/fr/fact-checks/sur-le-vif/30-60-des-medicaments-consommes-en-afrique-sont-ils-des-contrefacons
Ahmed, F., Eticha, T., & Ashenef, A. (2024). Quality assessment of anti-malarial medicines marketed in Gambella, National Regional State, South Western-Ethiopia. Malaria Journal, 23, 278. https://doi.org/10.1186/s12936-024-05091-x
Akpa, P. A., Ugwuoke, J. A., Attama, A. A., Ugwu, C. N., Ezeibe, E. N., Momoh, M. A., Echezona, A. C., & Kenechukwu, F. C. (2020). Improved antimalarial activity of caprol-based nanostructured lipid carriers encapsulating artemether-lumefantrine for oral administration. African Health Sciences, 20(4), 1679. https://doi.org/10.4314/ahs.v20i4.20
Amin, N. C., Fabre, H., Blanchin, M.-D., Montels, J., & Aké, M. (2013). Determination of artemether and lumefantrine in anti-malarial fixed-dose combination tablets by microemulsion electrokinetic chromatography with short-end injection procedure. Malaria Journal, 12, 202. https://doi.org/10.1186/1475-2875-12-202
César, I. da C., Andrade Nogueira, F. H., & Antônio Pianetti, G. (2008). Simultaneous determination of artemether and lumefantrine in fixed dose combination tablets by HPLC with UV detection. Journal of Pharmaceutical and Biomedical Analysis, 48(3), 951–954. https://doi.org/10.1016/j.jpba.2008.05.022
Cheng, M. P., & Yansouni, C. P. (2013). Management of severe malaria in the intensive care unit. Critical Care Clinics, 29(4), 865–885. https://doi.org/10.1016/j.ccc.2013.06.008
Girma, M., Umeta, B., Hasen, G., & Suleman, S. (2022). Quality of antimalarial drugs in East Africa: A systematic review. Infection and Drug Resistance, 15, 6085–6096. https://doi.org/10.2147/IDR.S373059
Heng, S., O’Meara, W. P., Simmons, R. A., & Small, D. S. (2021). Relationship between changing malaria burden and low birth weight in sub-Saharan Africa: A difference-in-differences study via a pair-of-pairs approach. eLife, 10, e65133. https://doi.org/10.7554/eLife.65133
PMC. (2024). Investigating in vitro and ex vivo properties of artemether/lumefantrine double-fixed dose combination lipid matrix tablets prepared by hot fusion. https://pmc.ncbi.nlm.nih.gov/articles/PMC8308765/DOI:103390
Izevbekhai, O., Adeagbo, B., Olagunju, A., & Bolaji, O. (2017). Quality of artemisinin-based antimalarial drugs marketed in Nigeria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 111(2), 90–96. https://doi.org/10.1093/trstmh/trx019
Karnad, D. R., Nor, M. B. M., Richards, G. A., Baker, T., & Amin, P. (2018). Intensive care in severe malaria: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care, 43, 356–360. https://doi.org/10.1016/j.jcrc.2017.11.007
Kaur, H., Allan, E. L., Mamadu, I., Hall, Z., Ibe, O., El Sherbiny, M., van Wyk, A., Yeung, S., Swamidoss, I., Green, M. D., Dwivedi, P., Culzoni, M. J., Clarke, S., Schellenberg, D., Fernández, F. M., & Onwujekwe, O. (2015). Quality of artemisinin-based combination formulations for malaria treatment: Prevalence and risk factors for poor quality medicines in public facilities and private sector drug outlets in Enugu, Nigeria. PLoS ONE, 10(5), e0125577. https://doi.org/10.1371/journal.pone.0125577
Kayentao, K., Ongoiba, A., Preston, A. C., Healy, S. A., Doumbo, S., Doumtabe, D., Traore, A., Traore, H., Djiguiba, A., Li, S., Peterson, M. E., Telscher, S., Idris, A. H., Kisalu, N. K., Carlton, K., Serebryannyy, L., Narpala, S., McDermott, A. B., Gaudinski, M., … Crompton, P. D. (2022). Safety and efficacy of a monoclonal antibody against malaria in Mali. The New England Journal of Medicine, 387(20), 1833–1842. https://doi.org/10.1056/NEJMoa2206966
Leroy, D., Campo, B., Ding, X. C., Burrows, J. N., & Cherbuin, S. (2014). Defining the biology component of the drug discovery strategy for malaria eradication. Trends in Parasitology, 30(10), 478–490. https://doi.org/10.1016/j.pt.2014.07.004
Médicaments contrefaits: Faits et chiffres. (2024). Afrique Sub-Saharienne. https://www.scidev.net/afrique-sub-saharienne/features/médicaments-contrefaits-faits-et-chiffres/
Médicaments contrefaits: Un problème de santé en Afrique. (2013). Afrique Renouveau. https://www.un.org/africarenewal/fr/magazine/mai-2013/m%C3%A9dicaments-contrefaits-un-probl%C3%A8me-de-sant%C3%A9-en-afrique
Ogbuanu, I. U., Otieno, K., Varo, R., Sow, S. O., Ojulong, J., Duduyemi, B., Kowuor, D., Cain, C. J., Rogena, E. A., Onyango, D., Akelo, V., Tippett Barr, B. A., terKuile, F., Kotloff, K. L., Tapia, M. D., Keita, A. M., Juma, J., Assefa, N., Assegid, N., … Bassat, Q. (2024). Burden of child mortality from malaria in high endemic areas: Results from the CHAMPS network using minimally invasive tissue sampling. Journal of Infection, 88(3), 106107. https://doi.org/10.1016/j.jinf.2024.01.006
Petersen, A., Held, N., & Heide, L. (2017). Surveillance for falsified and substandard medicines in Africa and Asia by local organizations using the low-cost GPHF Minilab. PLoS ONE, 12(9), e0184165. https://doi.org/10.1371/journal.pone.0184165
PMC. (n.d.). Quality of antimalarials in Kinshasa peri-urban areas with regard to local pharmaceutical legislation and regulation. https://pmc.ncbi.nlm.nih.gov/articles/PMC7322209/DOI:10.1093
Randall, G., & Seidel, J. S. (1985). Malaria. Pediatric Clinics of North America, 32(4), 893–916. https://doi.org/10.1016/S0031-3955(16)34861-1
Resende, L. A., da Silva, P. H. R., & Fernandes, C. (2019). Quantitative determination of the antimalarials artemether and lumefantrine in biological samples: A review. Journal of Pharmaceutical and Biomedical Analysis, 165, 304–314. https://doi.org/10.1016/j.jpba.2018.12.021
Rivelli, G. G., Ricoy, L. B. M., César, I. C., Fernandes, C., & Pianetti, G. A. (2018). Level A in vitro–in vivo correlation: Application to establish a dissolution test for artemether and lumefantrine tablets. Journal of Pharmaceutical and Biomedical Analysis, 155, 262–269. https://doi.org/10.1016/j.jpba.2018.03.063
Salami, R. K., Valente de Almeida, S., Gheorghe, A., Njenga, S., Silva, W., & Hauck, K. (2023). Health, economic, and social impacts of substandard and falsified medicines in low- and middle-income countries: A systematic review of methodological approaches. The American Journal of Tropical Medicine and Hygiene, 109(2), 228–240. https://doi.org/10.4269/ajtmh.22-0525
Seo, E. B., du Plessis, L. H., & Viljoen, J. M. (2022). Solidification of self-emulsifying drug delivery systems as a novel approach to the management of uncomplicated malaria. Pharmaceuticals, 15(2), 120. https://doi.org/10.3390/ph15020120
The International Pharmacopoeia - Eleventh Edition, 2022
Thellier, M., Simard, F., Musset, L., Cot, M., Velut, G., Kendjo, E., & Pradines, B. (2020). Changes in malaria epidemiology in France and worldwide, 2000–2015. Médecine et Maladies Infectieuses, 50(2), 99–‑112. https://doi.org/10.1016/j.medmal.2019.06.002
Umapathi, R., Das, A. K., Kumar, G. S., & Basu, S. (2023). Advanced drug delivery systems for artemisinin and its derivatives: Promising strategies for improved antimalarial efficacy. Drug Delivery and Translational Research, 13(1), 125–141. https://doi.org/10.1007/s13346-022-01177-w
Venkatesan, P. (2024). The 2023 WHO World malaria report. The Lancet Microbe, 5(3), e214.
https://doi.org/10.1016/S2666-5247(24)00016-8
Viljoen, J. M., Cilliers, L., & Plessis, L. H. du. (2024). Developing Self-Nanoemulsifying Drug Delivery Systems Comprising an Artemether–Lumefantrine Fixed-Dose Combination to Treat Malaria. Frontiers in Bioscience-Elite, 16(3), Article 3. https://doi.org/10.31083/j.fbe1603025
Wells, T. N. C., van Huijsduijnen, R. H., & Van Voorhis, W. C. (2015). Malaria medicines: A glass half full? Nature Reviews Drug Discovery, 14(6), 424–442. https://doi.org/10.1038/nrd4573
White, N. J., Pukrittayakamee, S., Hien, T. T., Faiz, M. A., Mokuolu, O. A., & Dondorp, A. M. (2014). Malaria. The Lancet, 383(9918), 723–735. https://doi.org/10.1016/S0140-6736(13)60024-0
World Health Organization. (2023). World malaria report 2023. https://www.who.int/publications/i/item/9789240079012
World Health Organization. (2017). A study on the public health and socioeconomic impact of substandard and falsified medical products. https://www.who.int/publications/i/item/9789241513430
World Health Organization. (2021). Substandard and falsified medical products. https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.