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Artemether-lumefantrine: is it effective for treating uncomplicated malaria?

The World Health Organisation (WHO) is promoting artemisinin combination therapy to combat emerging malaria drug resistance. Artemether-lumefantrine is one such combination and is the only fixed-dose artemisinin combination widely available. The six-dose regimen is recommended following its addition to the WHO Essential Drugs List. How does it compare to other anti-malarial drugs? Which dose regimen is the most effective? Researchers at the Liverpool School of Tropical Medicine conducted a Cochrane systematic review of study results to answer these questions.

The review examined eight randomised controlled trials comparing artemether-lumefantrine with chloroquine (2 trials); halofantrine (1); sulfadoxine-pyrimethamine (1); mefloquine (1) and mefloquine rtesunate (3). Six trials used the four-dose regimen and two trials used the six-dose regimen

The researchers found that:
for day 28 parasitaemia (presence of parasites in the blood) the four-dose regimen performed better than chloroquine in areas with high levels of chloroquine resistance in two studies. However, higher failure rates were seen with artemether-lumefantrine compared to sulfadoxine-pyrimethamine, mefloquine, halofantrine and mefloquine-artesunate
for the six-dose regimen, artemether-lumefantrine was associated with higher failure rates on day 28 when compared with mefloquine-artesunate but only two studies have been conducted and both were small
fever, parasite and gametocyte clearance times were faster with artemether-lumefantrine compared with single therapy.

The reviewers concluded that:

the four-dose regimen has no advantage over mefloquine, halofantrine and mefloquine-artesunate
research had not demonstrated that the six-dose regimen was superior or inferior to mefloquine-artesunate, mainly because there were only two small trials
properly conducted randomised comparisons against existing regimens are required before artemether-lumefantrine is introduced. Studies should be conducted through general health services so adherence is similar to real life.

Source(s):
‘Artemether-lumefantrine for treating uncomplicated falciparum malaria (Cochrane Review)’, in The Cochrane Library 2, by A.A.A. Omari, 2003 Full document.
More information about the Cochrane Library Full document.

Funded by: Effective Health Care Alliance Programme (DFID funded)

id21 Research Highlight: 23 July 2003

Further Information:
Aika Omari
International Health Research Group
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool
L3 5QA
UK

Tel: +44 (0) 151 705 3202
Fax: +44 (0) 151 705 3364
Contact the contributor: aika@liv.ac.uk

Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine (LSTM), UK

Views expressed on these pages are not necessarily those of DFID, IDS, id21 or other contributing institutions. Unless stated otherwise articles may be copied or quoted without restriction, provided id21 and originating author(s) and institution(s) are acknowledged.

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