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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

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