Anti-malaria pioneers

A new study published today in The Lancet shows millions of lives could be saved thanks to St George’s anti-malaria pioneers

 9^th December 08

Early research by St George’s, University of London has laid the foundations for a new anti-malaria treatment that could save millions of lives. Malaria causes more than a million deaths a year, with 90% of all cases occurring in Africa.

Early research by St George’s, University of London has laid the foundations for a new anti-malaria treatment that could save millions of lives. Malaria causes more than a million deaths a year, with 90% of all cases occurring in Africa.

St George’s researchers carried out one of the first trials of rectally-delivered artesunate on children with malaria. Now, following the success of those trials in Ghana, a new study published today by The Lancet’s Online First service has proven that rectal artesunate could halve the rate of malaria death and permanent disability in remote rural areas of Africa and Asia.

Artesunate is an anti-malaria drug from the artemisin group of drugs, derivatives of sweet wormwood that Chinese medics have used for thousands of years. Usually, it is taken as a pill or injected, and it quickly kills malaria parasites. However, a suppository version has been developed for situations where neither oral treatment nor injections are options. It is intended as an emergency measure to prevent patients from dying in the critical period before they are able to access adequate healthcare. The majority of malaria deaths are of young children in rural areas. In severe cases, patients are unable to swallow oral medication, and many also live far from any hospitals or clinics where they can receive definitive treatment by injection.

In 2001, Professor Sanjeev Krishna and his team at St George’s Centre For Infection published the results of the first trials of this form of rectal artesunate in children suffering from malaria where treatment could not be given by mouth. His team conducted trials in Ghana of children aged from 18 months to seven years. The study was done in a hospital environment with access to injective treatment. It showed that, in theory, rectal artesunate could save the lives of children awaiting transfer for definitive treatment. The success of the latest study is satisfying news for Professor Krishna and his team.

He said: “It is gratifying to see some of our earlier work on rectal artesunate in children in hospital now taken so successfully to the community. These results suggest that we now have a new weapon in our fight against malaria, and I hope that regulatory authorities can license the use of rectal artesunate as soon as possible.”

The new study, led by Dr Melba Gomes of the World Health Organization and her colleagues from the 13 Research Group, examined the effects of rectal artesunate on patients with acute malaria in Bangladesh, Ghana and Tanzania.

The study took place in 291 rural villages across the three countries, and 17,826 people with suspected malaria took part. In Africa, all the patients were children aged between six months and six years. But in Asia, half were similarly-aged children and half were older children or adults. The patients were randomly allocated either an artesunate suppository or a placebo. A total of 8,954 were given artesunate and 8,872 a placebo. Most had a drop of blood taken for analysis, and 4,648 samples were found to have no malaria parasites present. These patients were discounted.

The results showed there was no significant difference in death or permanent disability rates of those remaining patients who were able to reach a clinic for injections within six hours. However, many patients were unable to reach a clinic within six hours, and half of these had still not arrived after 15 hours. Among these patients, there were dramatic improvements and rectal artesunate was shown to halve the risk of death or permanent disability. Of the 1,566 artesunate patients without further treatment after six hours, 29 died or were permanently disabled. Of the placebo patients, the figure was 57 out of 1,519.

The study report said: “Death from malaria reflects delay in administration of effective anti-malarial treatment. Our results provide strong evidence that if patients with severe malaria cannot be treated orally and referral is likely to take several hours, an immediate rectal dose of artesunate before referral substantially reduces the risk of death or permanent disability.”

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