Artesunate - Mefloquine is highly effective
Little-used malaria drug combo gets another look
Health officials might need to reconsider malaria treatment priorities in Africa after a new study showed that an overlooked drug combination is effective and well-tolerated in young African children.
The findings were published today inThe Lancet and provide encouraging news in the continuing fight against malaria.
The researchers compared the commonly administered artemether-lumefantrine with the little-used artesunate-mefloquine option. Both are artemisinin-based combination therapy (ACT) formulations, which have gained popularity in the last 10 years as they offer a one-two punch against Plasmodium falciparuminfection and fight off artemisinin resistance. Though mefloquine is an established anti-malarial drug, it has a bad reputation for being hard to tolerate and causing vomiting.
The new study suggests that it was effective in treating malaria in preschool-age children and caused no more side effects than standard treatments.
About 90% effective, similar adverse events
Researchers targeted 944 African children ages 6 months to 5 years who tested positive for malaria. Half the participants received artemether-lumefantrine (the most popular malaria medication in Africa) and the others got artesunate-mefloquine.
Both groups were treated for 2 or 3 days, with doses adjusted for age and not weight. At 63 days follow-up both groups had similar cure rates of 89.7 % for artemether-lumefantrine and 90.9% for artesunate-mefloquine.
For both drugs, no parasites were found in the blood at 72 hours after the start of treatment, and there were no psychiatric events. Vomiting and neurologic adverse events were also similar in both groups, with artesunate-mefloquine causing vomiting in 15.3% of patients, and artemether-lumefantrin in 16.8%. Vomiting was a focus of the study because it lowers patient adherence and limits how much of the medicine is absorbed.
In addition, the artesunate-mefloquine treatment group had lower rates of recurrence during the study's short follow-up than those in the artemether-lumefantrine group.
"We detected that, up to day 49, the cumulative rates of recrudescence and of re-infection were each delayed by about 7 days with artesunate-mefloquine relative to those with artemether-lumefantrine," the authors wrote. Mefloquine has a longer half-life, according to the researchers, which could help explain its protective properties.
Promising alternative
Though easily treated, malaria still takes more than 400,000 lives per year, the vast majority in Africa (90%, 70% of whom are children). Currently, artesunate-mefloquine is not used in Africa, even though it's one of the five ACT therapies approved for malaria treatment by the World Health Organization. It's used widely in Latin America and Asia, however.
"Its [mefloquine's] increased availability could offer an efficacious treatment with rapid action and prolonged protection from re-infection; an important resource in the fight against malaria," said Alice C. Eziefula, MRCP, from the London School of Hygiene and Tropical Medicine, writing in a commentary about the study.
Source : The Lancet
Source : The Lancet
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