Artesunate plus pyronaridine for treating uncomplicated Plasmodium falciparum malaria

Hasifa Bukirwa1, B Unnikrishnan2, Christine V Kramer3, David Sinclair4, Suma Nair5, Prathap Tharyan6

Makerere University Medical School, Kampala, Uganda
Kasturba Medical College, Department of Community Medicine, Mangalore, Karnataka, India
Liverpool School of Tropical Medicine, Cochrane Infectious Diseases Group, Liverpool, UK
Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
Kasturba Medical College, Community Medicine, Manipal, Udupi, India
Christian Medical College, South Asian Cochrane Network & Centre, Prof. BV Moses Centre for Evidence-Informed Health Care and Health Policy, Vellore, Tamil Nadu, India

Artesunate plus pyronaridine for treating uncomplicated Plasmodium falciparum malaria. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD006404.

To read the full review please follow this link: DOI: 10.1002/14651858.CD006404.pub2. 

What is uncomplicated malaria and how might artesunate-pyronaridine work

Uncomplicated malaria is the milder form of malaria which usually causes fever, with or without headache, tiredness, muscle pains, abdominal pains, nausea, and vomiting. If left untreated, uncomplicated malaria can rapidly develop into severe malaria with kidney failure, fitting, unconsciousness, and eventually death. Plasmodium falciparum is the most common parasite causing malaria in sub-Saharan Africa and causes most of the severe malaria worldwide.

The World Health Organization currently recommends countries use one of five different artemisinin-based combination therapies (ACTs) to treat malaria. These combinations contain an artemisinin component (artemether, dihydroartemisinin, or artesunate), which works quickly to clear the parasite from the person's blood, and a longer-acting drug which clears the remaining parasites from the blood and may prevent new Plasmodium infections for several weeks. Artesunate plus pyronaridine is a new combination and in this review we evaluate its effectiveness and safety compared to the other ACTs.

After examining the research published up to 16 January 2014, we included six randomized controlled trials, enrolling 3718 children and adults.

What the research says

Based on studies of mostly older children and adults living in Africa and Southeast Asia, artesunate-pyronaridine is probably as effective as artemether-lumefantrine at treating uncomplicated malaria and preventing further malaria infections after treatment (moderate quality evidence).

In a study primarily of older children and adults in Asia, artesunate-pyronaridine is probably as effective as artesunate plus mefloquine at treating P. falciparum malaria and preventing recurrent parasitaemias (moderate quality evidence).

Serious adverse events were rare in people treated with either artesunate-pyronaridine or other ACTs. However, short-lasting liver toxicity was more frequent in people treated with artesunate-pyronaridine than with the other antimalarials (moderate quality evidence).

Authors' conclusions

Artesunate-pyronaridine performed well compared to the other two ACT with which it has been compared, but further studies in African and Asian children are required to help clarify whether this combination is an option for first-line treatment.