Infectious Disease

Intravenous artesunate safe, effective in treating severe malaria

August 29, 2021

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Intravenous artesunate was safe and effective in treating severe malaria in adults in the United States, researchers in Clinical Infectious Diseases reported.

Artesunate became the first-line treatment for severe malaria in the United States in 2019 after Eli Lilly stopped manufacturing quinidine, which was the only FDA-approved drug for the disease. Since then, the FDA has approved artesunate for severe malaria.

Anopheles gambiae

The female Anopheles mosquito transmits Plasmodium falciparum, the deadliest parasitic Plasmodium species that causes malaria in humans. Source: CDC / James Gathany.

For studying, Francisca Abanyie, MD, an investigator with CDC’s Infestations and Malaria Division, and colleagues studied 280 adult malaria patients who received intravenous artesunate (IV AS) from April 2019 to December 2020. Most of the patients were male (61.4%), black (75%) and infected with Plasmodium falciparum (83.6%). Their mean age was 35 years (IQR, 15.8–53.9).

According to Abanyie and colleagues, the most commonly reported criteria for need for IV-AS were parasitemia greater than 5% (75%), acute kidney damage (32.1%), and signs of cerebral malaria (29.3%).

Based on the protocol recommendations at the time of treatment, 154 patients (55%) were prescribed four-dose IV-AS treatment and 126 (45%) received three-dose treatment. Of these, 262 patients received all recommended doses.

Of 170 patients for whom information was available, the third dose of IV AS reduced parasitemia to less than 1% in almost all of them (93.5%), and most required only two doses to reach this threshold Abanyie and colleagues reported.

There was no significant difference in clearance times between participants who received oral therapy and those who hadn’t before IV-AS, the researchers said.

Five participants died, all of severe malaria. Adverse events related to IV AS were reported in approximately 5% of participants.

“Immediate administration of IV AS is a life-saving therapy,” the authors write. “All but five patients treated with IV AS survived; all deaths were attributed to complications from severe malaria. While no direct comparison was made with quinidine-treated patients in this study, the observed mortality rate in our cohort (1.8%) appears to be lower than in patients with severe malaria treated with quinidine (3%) in the US between the Years 2012 to 2017 were treated. “

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