Objectives: To assess the effects of iron-chelating agents combined with antimalarial drugs, or iron chelators alone, for treating Plasmodium falciparum malaria in adults and children, in relation to mortality, coma recovery time, parasite clearance, and adverse effects. Study selection criteria: All randomised controlled trials comparing iron chelating agents with placebo, or comparing iron chelating agents in conjunction with other antimalarials with antimalarial treatment alone in adults or children with falciparum malaria. Main results: Seven trials involving 570 participants were included. Two trials involving 435 children compared the iron chelator DFO with placebo and standard treatment. No evidence of benefit or harm was shown in relation to mortality, but studies were small. The risk of experiencing persistent seizures was lower with DFO compared to placebo treatment (RR 0.80, 95% CI 0.67 to 0.95), but adverse effects were more common in the DFO group. One trial involving 45 adults and children compared the orally active iron chelator (deferiprone) with placebo and standard treatment; coma recovery (WMD -27 hrs; 95%CI -34.20 to -19.80) and parasite clearance (WMD -24 hrs; 95%CI -35.27 to -12.73) were significantly faster in the deferiprone group compared to placebo, but clinical significance cannot be assumed from this small trial. The authors reported no side effects during the study. Conclusions: There are insufficient data for any conclusions for both agents tested. There are non-significant trends towards harm (death) and potential benefit (fewer seizures) with DFO. With deferiprone, results suggest possible benefit (shorter coma recovery and parasite clearance).
The Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD001474. DOI: 10.1002/14651858.CD001474.