Partner researchers from the Effective Health Care Research Consortium, and the Cochrane Infectious Disease Group, both hosted at LSTM, published an independent review today examining the effects of intramuscular artemether for treating people with severe malaria, and comparing them to commonly used alternatives.
Severe malaria remains an important cause of child deaths, particularly in sub-Saharan Africa, where the World Health Organization (WHO) estimates there are 600,000 deaths each year. In 2011, the WHO changed its recommendation for the treatment of severe malaria from quinine to artesunate, based on high quality evidence that artesunate saved more lives. However, in some African countries artemether, a drug related to artesunate but with less favourable chemical properties, has become widely available and used as treatment. Consequently, this systematic review of artemether provides a timely summary of the evidence to guide international and national treatment policies.
The authors looked at 18 randomized controlled trials carried out in Africa and Asia, including 2662 adults and children. They found no trials directly comparing artemether with artesunate in children, but two trials from Asia showed higher mortality in adults treated with artemether. Sixteen trials compared artemether with quinine, and while the number of deaths was very similar between the two treatments in children, in adults in Asia there were more deaths in those treated with quinine.
“Although there is a lack of direct evidence comparing artemether with artesunate, the indirect evidence strongly suggests that artemether will be less effective than artesunate at preventing deaths from severe malaria” says lead author Ekpereonne Esu from University of Calabar, Nigeria, “However, in circumstances where artesunate is not available, artemether is an effective alternative to quinine.”
Read the full review here.