Malaria
Artesunate shown to be more effective than Quinine in severe malaria
By Research Australia
Aug 27, 2005 - 3:41:00 AM

A drug derived from an ancient Chinese herb has been shown to reduce the risk of death from severe malaria by a third, potentially saving hundreds of thousands of lives in nations on our doorstep.

A trial in malaria patients from four countries has shown a clear benefit over standard treatment with quinine, says Professor Nicholas Anstey of the Menzies School of Health Research in Darwin, Australia, which participated in the trial in partnership with the Indonesian Ministry of Health.

The regional collaboration between the Indonesian Ministry of Health and Darwin's Menzies School of Health Research has a joint research facility in Timika in Papua province, eastern Indonesia. Hospitals in Bangladesh, Myanmar (Burma), and India also participated in the study, which was coordinated by the Wellcome Trust Unit in Bangkok, Thailand.

The results of the trial are reported in the latest edition of the international medical journal, Lancet, which is published today.

Quinine has been the standard drug for the treatment of severe malaria in most countries, Professor Anstey said. This new trial clearly shows that artesunate, derived from sweet wormwood, or Artemisia annua, has fewer side effects and is more effective than quinine in preventing death in adults with severe malaria.

In total, 1461 patients with severe malaria were treated with either quinine or artesunate. Of these, 20% were enrolled at the Indonesian Ministry of Health/Menzies field site in Papua province.

There were a third fewer deaths among those receiving artesunate: 15% of seriously ill patients died compared to 22% of those treated with quinine.

"Falciparum malaria, the most severe form of the infection, is a major cause of death in our region. At least 120 million cases of falciparum malaria occur in South East Asia each year," Professor Anstey said.

"The reduction in mortality from severe malaria associated with artesunate therapy is excellent news for the poorest communities of the region," he said. "This is the first time that any drug has been demonstrated to be better than quinine at saving lives since the latter was first introduced into Europe nearly 400 years ago."

As a result of this study the Indonesian Ministry of Health has already decided to change national drug policy for treatment of severe malaria from quinine to artesunate.

"The major aim of our collaborative studies in Papua with the Indonesian Ministry of Health is to improve the treatment of malaria and to provide information to policy makers," Professor Anstey said. "We were pleased that the participation of the Indonesian Ministry of Health/Menzies field site in this multi-centre study has contributed to national policy change."

Professor Anstey said a key feature of the trial was the collaboration of dozens of investigators in the four Asian countries, coordinated by Dr Arjen Dondorp and Professor Nick White at the Wellcome Trust Unit at Mahidol University in Bangkok.

The Principal investigator from the Indonesian Ministry of Health was Dr Emiliana Tjitra. The Indonesian Ministry of Health and Menzies School of Health Research contributed a joint team of 13 staff at their research site in Papua Province.

The trials, conducted between June 2003 and May 2005, were funded by a grant from the Wellcome Trust and coordinated as part of the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme funded by the Wellcome Trust of Great Britain.

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