What is uncomplicated malaria and how might artesunate-pyronaridine
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
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
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.
Bukirwa, H.; Unnikrishnan, B.; Kramer, C.V.; Sinclair, D.; Nair, S.; Tharyan, P. Artesunate plus pyronaridine for treating uncomplicated Plasmodium falciparum malaria. Cochrane Database of Systematic Reviews (2014) (Issue 3) Art. No.: CD006404. [DOI: 10.1002/14651858.CD006404.pub2]
Artesunate plus pyronaridine for treating uncomplicated Plasmodium falciparum malaria