Abstract
Artemisinin (ART) combination therapy is the main treatment for malaria. Pfk13 mutations (or K13 mutations, Kelch 13) are associated with ART resistance. This study aims to conduct a systematic review and meta-analysis of the prevalence of K13 mutations with ART resistance in malaria-endemic countries. An electronic search of studies in 2018 and a manual search in 2020 were performed to identify relevant studies. The risk of bias was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. Data analysis was performed using R 4.1.0. Heterogeneity was estimated using the statistic I2 and Cochran Q test. A total of 170 studies were included in our review. Of these, 55 studies investigated the prevalence of K13 mutations in Southeast Asia. The meta-analysis showed that Southeast Asia had the highest prevalence of K13 mutations, whereas Africa, South America, Oceania, and other Asian countries outside Southeast Asia had a low prevalence of K13 mutations. The C580Y mutation was the most common in Southeast Asia with 35.5% (95%CI: 25.4–46.4%), whereas the dominant mutation in Africa was K189T (22.8%, 95%CI: 7.6–43.2%). This study revealed the emergence of ART resistance associated with K13 mutations in Southeast Asia. The diversity of each type of K13 mutation in other regions was also reported.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
We would like to thank Kirellos Said Abbas (Faculty of Medicine, Alexandria University, Alexandria, Egypt) and Gehad Mohamed Tawfik (Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt) for their contributions during the initial stages of the study. We also thank Peterson Gtionga Mathenge (Harvard Medical School, USA) for proofreading the manuscript.
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KH and NTH developed the idea, conceived, and designed the study. DTH, LT, and DNHT performed literature search and data collection. DTH analyzed and synthesized the data. DTH assessed the quality of the included studies. DTH, LT, and AA interpreted the results and wrote the manuscript. All authors critically checked the data, reviewed and edited the manuscript. KH, NTH provided supervision and project administration. All authors have read and approved the final manuscript.
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Hung, D.T., Tran, L., Tam, D.N.H. et al. The prevalence of Pfk13 polymorphism in malaria patients treated with artemisinin-based therapy: a systematic review and meta-analysis. Parasitol Res 123, 209 (2024). https://doi.org/10.1007/s00436-024-08203-3
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DOI: https://doi.org/10.1007/s00436-024-08203-3