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.
Background on malaria
Malaria is a leading cause of death and disease worldwide characterised by recurrent bouts of fever. It is caused by a blood parasite transmitted by the Anopheles mosquito, with 95% of the world's malaria occurring in tropical regions of Africa and Asia. Once in the blood, red cells rupture, releasing toxins which cause fever, chills and flu-like malaria symptoms. Sometimes it can result in severe malaria in which multiple organs are affected like the brain, kidneys and lungs. It was in these patients that the artesunate treatment was compared with standard quinine treatment.
Malaria affects over 550 million people each year, 120 million in South and South East Asia, with over two million deaths worldwide.
There are four kinds of malaria: Plasmodium falciparum (known as P. falciparum), P. vivax, P. ovale and P. malariae. Almost all of the world's 2 million deaths are from P. falciparum.
Background on Menzies School of Health Research
The Menzies School of Health Research is a national leader in Indigenous, tropical and remote health and an innovative centre for public health and research education. It recently celebrated its 20th anniversary.
The Malaria and International Health Program at Menzies School of Health Research has been conducting malaria and TB research in collaboration with the Indonesian Ministry of Health's National Institute of Health Research and Development for the past nine years.
The program involves a wide range of projects aimed at improving diagnosis, treatment and prevention of malaria and TB, with a focus on evaluating new and affordable treatments for malaria, combination therapies for malaria, and improving understanding and treatment of severe malaria.
A significant component of Menzies' research is in Timika, Papua province, Indonesia, where drug-resistant malaria is a major problem. A joint National Institute of Health Research and Deveopment/Menzies School of Health Research team of over 20 research staff is based in Timika.
What is artesunate?
Artesunate is derived from a Chinese herb, Artemisia annua (sweet wormwood), which has been used for centuries as a treatment for malaria. Artesunate and artemethere are derived from artemisinin, which has been used as an oral antimalarial in China and Vietnam for the past 30 years. Artesunate was rediscovered in China in 1972 and, although it has been used widely, this is the first definitive trial comparing its use with quinine in seriously ill patients. It is the largest comparative drug trial ever performed in severe malaria.
Artesunate has proved ideal for the treatment of severe malaria and is active against multi-drug resistant strains of P. falciparum.
Quinine
Quinine has been used to treat malaria for nearly 400 years. It was originally derived from the bark of the Cinchona tree and was introduced to European medicine in the 1630s.
Media inquiries to Professor Nicholas Anstey 61-889-228-932 or Alison Ellis on 61-889-228-989 or mobile 61-422-585-917
Journal
The Lancet