The objective of the present study was to compare the efficacy and safety in the Central African Republic ( CAR ) of three commercially available artemisinin-based combinations , artemether + lumefantrine ( AL ) , artesunate + sulphamethoxypyrazine-pyrimethamine ( AS-SMP ) and artesunate + amodiaquine ( AS-AQ ) , with those of sulphadoxine-pyrimethamine + amodiaquine ( SP-AQ ) , which was the first-line reference treatment in the country from 2004 , until it was replaced by ACT in 2006 in accordance with changes in international recommendations based on resistance identified in other regions .