Artesunate drip shows therapeutic benefit in severe malaria

Patients with severe imported malaria appear to fare well with intravenous artesunate, despite an increased incidence of mild-to-moderate post-treatment delayed haemolysis, as reported in a study.

The study included 1,391 artesunate-treated patients recruited from 110 participant centres during the first 7 years (2011–2017) of a national programme implemented by the French Drug Agency. Researchers analysed the clinical and epidemiological features of the patients.

Artesunate became the most frequently used drug to treat severe malaria in France, with uptake rising from 9.9 percent in 2011 to 71.4 percent in 2017. Mortality in the cohort was at 4.1 percent.

Twenty-seven patients experienced treatment failure, although none of them had mutations in the Kelch-13 gene.

Commonly reported adverse events (AE) included anaemia (136 cases), cardiac events (24, including 20 episodes of conduction disorders and/or arrhythmia), and liver enzyme elevation (23 episodes). Mortality and AE rates were similar in the general population and in HIV-infected, overweight, or pregnant patients. However, a single pregnant woman treated in the first trimester had a haemorrhagic miscarriage.

The incidence of post-artesunate delayed haemolysis (PADH) was relatively high at 42.8 percent, when specifically assessed in a 98-patient subgroup. This event was associated with neither fatal outcomes nor sequelae. Furthermore, PADH was twice as frequent in patients of European than of African origin.

Additional investigation in the context of importation is needed to assess outcomes during the first trimester of pregnancy and identify rare but potentially severe cardiac AEs.