Intervention Review

Artemisinin derivatives for treating uncomplicated malaria

  1. Heather McIntosh1,*,
  2. Piero Olliaro2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 26 APR 1999

Assessed as up-to-date: 17 FEB 1999

DOI: 10.1002/14651858.CD000256


How to Cite

McIntosh H, Olliaro P. Artemisinin derivatives for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 1999, Issue 2. Art. No.: CD000256. DOI: 10.1002/14651858.CD000256.

Author Information

  1. 1

    University of Edinburgh, Community Health Sciences General Practice, Edinburgh, UK

  2. 2

    World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland

*Heather McIntosh, Community Health Sciences General Practice, University of Edinburgh, 20 West Richmond Street, Edinburgh, EH8 9DX, UK. hmmci@tiscali.co.uk.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 26 APR 1999

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

Artemisinin derivatives are a relatively new group of drugs with antimalarial properties. As resistance to other antimalarial drugs continues to increase, artemisinin drugs may be useful alternatives.

Objectives

The objective of this review was to assess the effects of artemisinin drugs for treating uncomplicated falciparum malaria.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Science Citation Index, LILACS, African Index Medicus, conference abstracts, and reference lists of relevant articles. We contacted organisations, researchers in the field, and drug companies.

Selection criteria

Randomised and quasi-randomised trials of artemisinin derivatives, alone or in combination with other antimalarials, compared with standard antimalarial treatments, in adults or children with uncomplicated falciparum malaria. Only trials where treatment was given by mouth or suppository were included. Comparisons between different artemisinin derivatives and treatment regimens were also included.

Data collection and analysis

Eligibility and trial quality were assessed and data were extracted independently by the two reviewers.

Main results

Forty-one trials involving over 5000 patients were included. Variation in study design and quality made synthesis of the data problematic. Allocation concealment was adequate in only two trials. Most data were from areas of multidrug resistant falciparum malaria in South-East Asia. Compared with standard antimalarial treatments, artemisinin drugs showed fast parasite clearance and high cure rates at follow-up, provided the duration of treatment with artemisinin drugs was adequate. Combination with mefloquine improved sustained parasite clearance and was effective in multidrug resistant areas. When doses were adequate, the combination shortened the duration of treatment. We found no evidence that artemisinin drugs are more harmful than standard treatment drugs over a typical trial period of 28 days.

Authors' conclusions

The evidence suggests that artemisinin drugs are effective and safe for treating uncomplicated malaria. There is no evidence from randomised trials that one artemisinin derivative is better than the others. In areas where there is mefloquine resistance, combination therapy with an artemisinin derivative appears to improve sustained parasite clearance compared with either drug alone.

This review summarizes trials up to 1999. For the reasons in the 'What's new' section, this review will no longer be updated.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Artemisinin drugs for treating uncomplicated malaria are better used in combination therapy

Artemisinin drugs come originally from a plant that has been used since ancient times in China as a traditional medicine for fever and malaria. These drugs act quickly and few side effects have been reported. Malaria parasites have so far not developed resistance to artemisinin drugs. The review shows that artemisinin drugs clear malaria parasites from the blood more effectively than standard treatment drugs. In areas where malaria parasites are more resistant to existing drugs, such as South-East Asia, artemisinin drugs are not better at sustained parasite clearance than standard treatment with quinine or mefloquine. Combination treatment using an artemisinin drug together with the longer-acting antimalarial drug mefloquine improves sustained clearance of parasites, but mefloquine is associated with adverse effects. There are few studies on combination treatment with longer-acting antimalarial drugs that are safer than mefloquine. There is no evidence from trials that any of the several artemisinin derivatives is better than the others.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

以Artemisinin衍生物治療非複雜性瘧疾

研究背景

Artemisinin衍生物是一種相對較新的藥物類型,具有抗瘧疾的功效。隨著其它瘧疾藥物的抗藥性不斷上升,artemisinin或許是個可行的替代藥物。

研究目的

本篇回顧的目的在於,評估以artemisinin類藥物治療非複雜性惡性瘧疾的療效。

检索方法

我們搜尋了the Cochrane Infectious Diseases Group trials register、the Cochrane Controlled Trials Register、Medline、Embase, Science Citation Index、Lilacs、African Index Medicus;會議摘要及相關溫張的參考文獻。我們和此領域的相關機構、研究者及藥物廠商研究。

纳入标准

以患有非複雜性惡性瘧及的成人或孩童為樣本,和其它標準抗瘧疾比較,探討單獨使用artemisinin類藥物,或併用其他抗瘧疾藥物治療瘧疾的隨機或半隨機試驗。我們只收錄以口服或栓劑給藥的試驗。同時也收錄以各種artemisinin類藥物互相比較,及比較各種治療方案的試驗。

数据收集与分析

由兩位作者分別執行試驗的品質及可用性的評估,並擷取數據。

主要结果

我們收錄了41個試驗,包含超過5000位病患。各研究的設計及品質的異質性,使得數據的合併困難重重。只有兩個試驗適合分配隱藏。許多數據都是來自流行多重抗藥性惡性瘧疾的東南亞國家。和標準的抗瘧疾治療相比,artemisinin類藥物在合適的治療持續時間下,清除寄生蟲的速度較快,且治癒率較高。併用mefloquine可以改善持續的寄生蟲清除率,而且對於多重抗藥性的瘧疾也是有效的。在合適的劑量下,這樣的藥物併用可以縮短治療的時間。我們沒有發現任何顯示artemisinin比標準治療藥物有更高毒性的證據。

作者结论

目前的證據顯示以artemisinin類藥物治療非複雜性瘧疾是有效且安全的。沒有任何來自隨機對照試驗的證據指出特定一種artemisinin衍生物,比另一種有效。在流行抗mefloquine瘧疾的地區,比起單獨使用其它的藥物,併用artemisinin類藥物似乎可以改善寄生蟲的清除率。本篇回顧將截至1999年的試驗做了整合。由於‘What's new’的關係,本篇回顧將不會再更新。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

以Artemisinin衍生物治療非複雜性瘧疾

使用Artemisinin類藥物治療非複雜性瘧疾時,最好併用其它藥物。Artemisinin藥物是由植物萃取而來,這種植物在古代中國用於治療發燒及瘧疾。這類的藥物作用迅速,且目前發現的負作用極少。目前沒有發現瘧疾寄生蟲對artemisinin類藥物產生抗藥性。本篇回顧顯示,artemisinin類藥物比標準治療藥物更能有效的清楚血液中的寄生蟲。在有抗藥性瘧疾寄生蟲的區域,像是東南亞,artemisinin的持續性寄生蟲的清除率,並沒有比標準治療藥物,像是quinine或mefloquine好。但併用長效型抗瘧疾藥物mefloquine和artemisinin類藥物,可以改善寄生蟲的持續清除率,但mefloquine有較多的不良反應。目前有少數試驗,正在測試併用其它比mefloquine更安全的長效型抗瘧疾藥物。目前沒有試驗證據指出特定的artemisinin類藥物比其它的好。

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