MALARIA: pyronaridine-artesunate

The new anti-malarial combination therapy pyronaridine-artesunate is as effective as the gold standard treatment, and the new regimen is inexpensive and only needs to be taken once daily.
Artemether-lumefantrine has long been regarded as the gold standard for treatment of malaria, with good safety and generally more than 90 percent efficacy. It must be taken twice a day, however, requires a fatty diet for optimum absorption, and the fairly short time taken to metabolize the treatment exposes patients to the risk of early re-infection. Scientists are trying to develop new artemisinin-based combination therapies that are equally convenient, effective and safe, such as pyronaridine-artesunate, to allow health policy makers and care givers in malaria endemic countries greater choice of effective treatment for their patients.
The phase 3 randomized trial was undertaken in seven sites in Africa and three sites in southeast Asia. Patients aged three years with uncomplicated Plasmodium falciparum malaria (the most common form) were randomly assigned either to receive pyronaridine-artesunate once a day or artemether-lumefantrine twice a day, orally for three days, plus respective placebo. Both treatments were given according to bodyweight. The primary efficacy was judged at day 28 by analysis of patients' blood for presence of malaria parasites.The final efficacy analysis consisted of 784 patients in the pyronaridine-artesunate group and 386 patients in the artemether-lumefantrine group. Treatment response occurred in 99.5 percent in the pyronaridine-artesunate group and 99.2 percent in the artemether-lumefantrine group.
There was a lower rate of re-infection and a longer time to re-infection in the pyronaridine-artesunate group than in the artemether-lumefantrine group. The percentage of adverse events was similar in the two groups and most of the adverse events were related to malaria itself. Mild and transient increases in liver enzymes were experienced in the pyronaridine-artesunate group but not in the artemether-lumefantrine group.
The authors were quoted as saying, "Fixed-dose pyronaridine-artesunate, given once a day for 3 days, showed high clinical and parasitological response rates and rapid parasite clearance, and was well tolerated in the treatment of uncomplicated P falciparum malaria. The efficacy of pyronaridine-artesunate still has to be assessed in a real-life setting across the wider population of patients who need anti-malarial treatment, including those who are malnourished or have anemia. However, in view of the results of this study and with a purchase price for pyronaridine-artesunate in the range of less than $1 for adults and less than $0.50 for children, this drug combination should be considered for inclusion in malaria treatment programs."
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