Traditional Chinese medicine ‘cuts malaria mortality rates by a third’

The trial, funded by the Wellcome Trust and conducted in Bangladesh, Burma, India and Indonesia, compared the effectiveness of two plant-derived drugs; Quinine, which is currently the drug of choice for severe malaria in most malaria-affected regions, against artesunate – a drug derived from artemisinin, a traditional Chinese medicine. The results were compelling –artesunate reduced mortality by 35% and was safer and easier to administer.

Professor Nick White, Chairman of the Wellcome Trust South East Asian Tropical Medicine Research Programmes, who led the project, is now calling for a comprehensive and immediate change in the treatment of severe malaria.

Prof White said:

“This is the first trial to show that the mortality of severe malaria can be reduced by improving the drug treatment. The results are very clear - using artesunate to treat patients with severe malaria saves lives.

“Quinine has been the accepted treatment for severe malaria since discovering the malaria parasite over a hundred years ago, but now we need to change that.

“Sometimes new treatments are thought to be more effective, but often there is a pay off in terms of finance, practicality of administering treatments or problematic side effects. That isn’t the case here.

“Artesunate is easier to use – it requires two injections on the day of hospital admission then a single injection a day, whereas quinine needs to be given three times a day. It also costs slightly less.”

Prof White, who is also chairman of the World Health Organisation (WHO) Antimalarial Treatment Guidelines committee, said:

“Artesunate is widely used in a tablet form, as part of a combination therapy, to treat patients with the early stages of malaria. This is now accepted as the best treatment for uncomplicated malaria. These remarkable results should bring an immediate change in WHO recommendations for severe malaria.”

The injection form of artesunate is produced in China, but it is not yet approved by regulatory authorities in many countries, therefore, it is not available.

Dr Arjen Dondorp, Vice Director of the research programme in Thailand, who helped coordinate the trial said:

“This treatment has been safely used by millions of people in Asia, which should encourage a degree of confidence.It is a matter of urgency to make a quality assured artesunate injection widely available.”

The project was conducted with almost 1,500 predominately adult, patients in centres across Bangladesh, India, Indonesia and Burma.

The results for adults with severe malaria are clear, but more information is needed in the treatment for children. Dr Dondorp and his colleagues are currently conducting another multicentre clinical trial, also funded by the Wellcome Trust, to identify if the successful results are mirrored in African children with severe malaria – one of the main groups to suffer.

It is estimated that there are over 500 million cases of malaria each year. It is one of the biggest killers in the world – accounting for almost 3,000 deaths a day, predominantly in Africa and South East Asia.

The research is published in today’s Lancet (27th August).