A nine-country trial of more than 5,000 children with severe malaria found that the drug artesunate performed significantly better than quinine, which has long been recommended in Africa’s high-transmission areas by the World Health Organization, according to results announced Saturday at a session at the 59th annual ASTMH conference.
The announcement drew cheers from a large crowd. The Lancet plans to publish the study online Monday, and an expert review panel at the WHO is now expected to revisit its recommendation for treatment of severe malaria in areas where transmission is high.
In the trial, called by its acronym AQUAMAT, 2,712 children received artesunate treatment, and 2,713 took quinine tablets. Some 297 children taking quinine died, or 10.9 percent, while 230 taking artesunate died, or 8.5 percent. It meant that 22.5 percent fewer children died taking artesunate.
``Artesunate should replace quinine everywhere in the world as the first-line treatment of severe falciparum malaria,’’ said Arjen M. Dondorp of Mahidol University in Bangkok and a leader of the study.
An estimated 8 million severe malaria cases occur each year. Dondorp said that the use of artesunate as the first-line drug theoretically would save 195,000 lives a year.
``But that,’’ he said, ``assumes that the drug will be available and reach those patients. Now we have to all make sure the drug gets to where it is needed.’’
An earlier trial – called SEAQUAMAT – in four southeast Asia countries of severe malaria also found that artesunate was more effective than quinine in reducing mortality; that study led to WHO to change its recommendation for treatment of severe malaria in low-transmission settings to artesunate.
That earlier trial prompted the AQUAMAT study to look at high-transmission areas of Africa to see if artesunate also would be more effective than quinine in those conditions.
In the nine-country Africa trial, researchers encountered the many types of life-threatening complications with severe malaria. Roughly one third had cerebral malaria with a coma, and 30 percent had severe anaemia.
The study sites were in Mozambique, Kenya, the Gambia, Ghana, Tanzania, Uganda, Nigeria, Rwanda, and the Democratic Republic of Congo. The first site started in 2005 in Mozambique. Dondorp said the trial had to keep expanding to find enough cases of severe malaria in the past few years, a result of success of malaria control programs in several countries.
He said 182 people worked on the trial, and he gave a ``big thanks to all the kids and caretakers who participated’’ as well as to the funder, Wellcome Trust.