Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies

BACKGROUND: Rectal administration of artemisinin derivatives has potential for early treatment for severe malaria in remote settings where injectable antimalarial therapy may not be feasible. Preparations available include artesunate, artemisinin, artemether and dihydroartemisinin. However each may...

Full description

Bibliographic Details
Main Authors:	Gomes, M., Ribeiro, I., Warsame, M., Karunajeewa, H., Petzold, M.
Format:	Journal Article
Language:	EN
Published:	2012
Subjects:	Administration, Rectal Adolescent Adult Aged Aged, 80 and over Animals Antimalarials Artemisinins therapeutic use Child Preschool Humans Infant Newborn Malaria Middle Aged Parasitemia/drug therapy Plasmodium falciparum
Online Access:	http://hdl.handle.net/10986/5085

id	okr-10986-5085
recordtype	oai_dc
spelling	okr-10986-50852021-04-23T14:02:20Z Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies Gomes, M. Ribeiro, I. Warsame, M. Karunajeewa, H. Petzold, M. Administration, Rectal Adolescent Adult Aged Aged, 80 and over Animals Antimalarials Artemisinins therapeutic use Child Preschool Humans Infant Newborn Malaria Middle Aged Parasitemia/drug therapy Plasmodium falciparum BACKGROUND: Rectal administration of artemisinin derivatives has potential for early treatment for severe malaria in remote settings where injectable antimalarial therapy may not be feasible. Preparations available include artesunate, artemisinin, artemether and dihydroartemisinin. However each may have different pharmacokinetic properties and more information is needed to determine optimal dose and comparative efficacy with each another and with conventional parenteral treatments for severe malaria. METHODS: Individual patient data from 1167 patients in 15 clinical trials of rectal artemisinin derivative therapy (artesunate, artemisinin and artemether) were pooled in order to compare the rapidity of clearance of Plasmodium falciparum parasitaemia and the incidence of reported adverse events with each treatment. Data from patients who received comparator treatment (parenteral artemisinin derivative or quinine) were also included. Primary endpoints included percentage reductions in parasitaemia at 12 and 24 hours. A parasite reduction of >90% at 24 hours was defined as parasitological success. RESULTS: Artemisinin and artesunate treatment cleared parasites more rapidly than parenteral quinine during the first 24 hours of treatment. A single higher dose of rectal artesunate treatment was five times more likely to achieve >90% parasite reductions at 24 hours than were multiple lower doses of rectal artesunate, or a single lower dose administration of rectal artemether. CONCLUSION: Artemisinin and artesunate suppositories rapidly eliminate parasites and appear to be safe. There are less data on artemether and dihydroartemisinin suppositories. The more rapid parasite clearance of single high-dose regimens suggests that achieving immediate high drug concentrations may be the optimal strategy. 2012-03-30T07:31:12Z 2012-03-30T07:31:12Z 2008 Journal Article BMC Infect Dis 1471-2334 (Electronic) 1471-2334 (Linking) http://hdl.handle.net/10986/5085 EN http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Journal Article
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	EN
topic	Administration, Rectal Adolescent Adult Aged Aged, 80 and over Animals Antimalarials Artemisinins therapeutic use Child Preschool Humans Infant Newborn Malaria Middle Aged Parasitemia/drug therapy Plasmodium falciparum
spellingShingle	Administration, Rectal Adolescent Adult Aged Aged, 80 and over Animals Antimalarials Artemisinins therapeutic use Child Preschool Humans Infant Newborn Malaria Middle Aged Parasitemia/drug therapy Plasmodium falciparum Gomes, M. Ribeiro, I. Warsame, M. Karunajeewa, H. Petzold, M. Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies
relation	http://creativecommons.org/licenses/by-nc-nd/3.0/igo
description	BACKGROUND: Rectal administration of artemisinin derivatives has potential for early treatment for severe malaria in remote settings where injectable antimalarial therapy may not be feasible. Preparations available include artesunate, artemisinin, artemether and dihydroartemisinin. However each may have different pharmacokinetic properties and more information is needed to determine optimal dose and comparative efficacy with each another and with conventional parenteral treatments for severe malaria. METHODS: Individual patient data from 1167 patients in 15 clinical trials of rectal artemisinin derivative therapy (artesunate, artemisinin and artemether) were pooled in order to compare the rapidity of clearance of Plasmodium falciparum parasitaemia and the incidence of reported adverse events with each treatment. Data from patients who received comparator treatment (parenteral artemisinin derivative or quinine) were also included. Primary endpoints included percentage reductions in parasitaemia at 12 and 24 hours. A parasite reduction of >90% at 24 hours was defined as parasitological success. RESULTS: Artemisinin and artesunate treatment cleared parasites more rapidly than parenteral quinine during the first 24 hours of treatment. A single higher dose of rectal artesunate treatment was five times more likely to achieve >90% parasite reductions at 24 hours than were multiple lower doses of rectal artesunate, or a single lower dose administration of rectal artemether. CONCLUSION: Artemisinin and artesunate suppositories rapidly eliminate parasites and appear to be safe. There are less data on artemether and dihydroartemisinin suppositories. The more rapid parasite clearance of single high-dose regimens suggests that achieving immediate high drug concentrations may be the optimal strategy.
format	Journal Article
author	Gomes, M. Ribeiro, I. Warsame, M. Karunajeewa, H. Petzold, M.
author_facet	Gomes, M. Ribeiro, I. Warsame, M. Karunajeewa, H. Petzold, M.
author_sort	Gomes, M.
title	Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies
title_short	Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies
title_full	Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies
title_fullStr	Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies
title_full_unstemmed	Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies
title_sort	rectal artemisinins for malaria : a review of efficacy and safety from individual patient data in clinical studies
publishDate	2012
url	http://hdl.handle.net/10986/5085
_version_	1764393879805624320

Rectal Artemisinins for Malaria : A Review of Efficacy and Safety from Individual Patient Data in Clinical Studies

Similar Items