(April 22, 2010 - Insidermedicine)
A new once daily combination therapy is as effective as the gold standard of twice daily artemether-lumefantrine for the treatment of uncomplicated falciparum malaria, according to a trial published in The Lancet.
Here are some recommendations for the treatment of malaria from the World Health Organization (WHO):
• To counter the threat of resistance of P. falciparum to monotherapies, and to improve treatment outcome, WHO recommends that artemisinin-based combination therapies
• There is still substantial geographic variability in the efficacy of available artemisinin-based combination therapy options, underlining the importance of countries regularly monitoring the efficacy of the artemisinin-based combination therapies in use
• The prevailing high levels of resistance to non-artemisinin as monotherapy have compromised their efficacy even in combinations.
Researchers out of the University of Kinshasa in the Democratic Republic of the Congo randomized 2,121 patients aged 3 to 60 with uncomplicated P falciparum malaria in a 2:1 ratio to receive pyronaridine plus artesunate once a day or artemether plus lumefantrine twice a day. Doses were based on body weight and treatment duration was three days.
The final efficacy analysis involved 1,170 patients. The PCR-corrected adequate clinical and parasitological response (ACPR) rate at day 28 was 99.5% among the 784 patients who took pyronaridine-artesunate and 99.2% among the 386 who took artemether-lumefantrine. The most frequent drug-related adverse event was eosinophilia, which occurred in 6.2% of patients taking pyronaridine-artesunate and 5.7% of those taking artemether-lumefantrine.
Today’s research indicates that once daily pyronaridine-artesunate should be considered for inclusion in malaria treatment programs, as it appears to be at least as effective as artemether-lumefantrine against uncomplicated falciparum malaria.