Artemisia annua and Artemisia afra tea infusions vs. artesunate-amodiaquine (ASAQ) in treating Plasmodium falciparum malaria in a large scale, double blind, randomized clinical trial.
Adolescent
Adult
Amodiaquine
/ adverse effects
Antimalarials
/ therapeutic use
Artemisia
Artemisia annua
Artemisinins
/ adverse effects
Child
Double-Blind Method
Drug Combinations
Female
Fever
/ drug therapy
Hemoglobins
/ metabolism
Humans
Malaria, Falciparum
/ drug therapy
Male
Middle Aged
Parasitemia
/ drug therapy
Plant Preparations
/ adverse effects
Plants, Medicinal
Treatment Outcome
ACT
ASAQ
Artemisinin
Clinical trial
Malaria
Tea infusion
Journal
Phytomedicine : international journal of phytotherapy and phytopharmacology
ISSN: 1618-095X
Titre abrégé: Phytomedicine
Pays: Germany
ID NLM: 9438794
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
05
01
2018
revised:
29
11
2018
accepted:
01
12
2018
pubmed:
23
1
2019
medline:
16
7
2019
entrez:
23
1
2019
Statut:
ppublish
Résumé
Prior small-scale clinical trials showed that Artemisia annua and Artemisia afra infusions, decoctions, capsules, or tablets were low cost, easy to use, and efficient in curing malaria infections. In a larger-scale trial in Kalima district, Democratic Republic of Congo, we aimed to show A. annua and/or A. afra infusions were superior or at least equivalent to artesunate-amodiaquine (ASAQ) against malaria. A double blind, randomized clinical trial with 957 malaria-infected patients had two treatment arms: 472 patients for ASAQ and 471 for Artemisia (248 A. annua, 223 A. afra) remained at end of the trial. ASAQ-treated patients were treated per manufacturer posology, and Artemisia-treated patients received 1 l/d of dry leaf/twig infusions for 7 d; both arms had 28 d follow-up. Parasitemia and gametocytes were measured microscopically with results statistically compared among arms for age and gender. Artemisinin content of A. afra was negligible, but therapeutic responses of patients were similar to A. annua-treated patients; trophozoites cleared after 24 h, but took up to 14 d to clear in ASAQ-treated patients. D28 cure rates defined as absence of parasitemia were for pediatrics 82, 91, and 50% for A. afra, A. annua and ASAQ; while for adults cure rates were 91, 100, and 30%, respectively. Fever clearance took 48 h for ASAQ, but 24 h for Artemisia. From D14-28 no Artemisia-treated patients had microscopically detectable gametocytes, while 10 ASAQ-treated patients remained gametocyte carriers at D28. More females than males were gametocyte carriers in the ASAQ arm but were unaffected in the Artemisia arms. Hemoglobin remained constant at 11 g/dl for A. afra after D1, while for A. annua and ASAQ it decreased to 9-9.5 g/dl. Only 5.0% of Artemisia-treated patients reported adverse effects, vs. 42.8% for ASAQ. A. annua and A. afra infusions are polytherapies with better outcomes than ASAQ against malaria. In contrast to ASAQ, both Artemisias appeared to break the cycle of malaria by eliminating gametocytes. This study merits further investigation for possible inclusion of Artemisia tea infusions as an alternative for fighting and eradicating malaria.
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
Prior small-scale clinical trials showed that Artemisia annua and Artemisia afra infusions, decoctions, capsules, or tablets were low cost, easy to use, and efficient in curing malaria infections. In a larger-scale trial in Kalima district, Democratic Republic of Congo, we aimed to show A. annua and/or A. afra infusions were superior or at least equivalent to artesunate-amodiaquine (ASAQ) against malaria.
METHODS
METHODS
A double blind, randomized clinical trial with 957 malaria-infected patients had two treatment arms: 472 patients for ASAQ and 471 for Artemisia (248 A. annua, 223 A. afra) remained at end of the trial. ASAQ-treated patients were treated per manufacturer posology, and Artemisia-treated patients received 1 l/d of dry leaf/twig infusions for 7 d; both arms had 28 d follow-up. Parasitemia and gametocytes were measured microscopically with results statistically compared among arms for age and gender.
RESULTS
RESULTS
Artemisinin content of A. afra was negligible, but therapeutic responses of patients were similar to A. annua-treated patients; trophozoites cleared after 24 h, but took up to 14 d to clear in ASAQ-treated patients. D28 cure rates defined as absence of parasitemia were for pediatrics 82, 91, and 50% for A. afra, A. annua and ASAQ; while for adults cure rates were 91, 100, and 30%, respectively. Fever clearance took 48 h for ASAQ, but 24 h for Artemisia. From D14-28 no Artemisia-treated patients had microscopically detectable gametocytes, while 10 ASAQ-treated patients remained gametocyte carriers at D28. More females than males were gametocyte carriers in the ASAQ arm but were unaffected in the Artemisia arms. Hemoglobin remained constant at 11 g/dl for A. afra after D1, while for A. annua and ASAQ it decreased to 9-9.5 g/dl. Only 5.0% of Artemisia-treated patients reported adverse effects, vs. 42.8% for ASAQ.
CONCLUSION
CONCLUSIONS
A. annua and A. afra infusions are polytherapies with better outcomes than ASAQ against malaria. In contrast to ASAQ, both Artemisias appeared to break the cycle of malaria by eliminating gametocytes. This study merits further investigation for possible inclusion of Artemisia tea infusions as an alternative for fighting and eradicating malaria.
Identifiants
pubmed: 30668322
pii: S0944-7113(18)30596-8
doi: 10.1016/j.phymed.2018.12.002
pmc: PMC6990969
mid: NIHMS1067690
pii:
doi:
Substances chimiques
Antimalarials
0
Artemisinins
0
Drug Combinations
0
Hemoglobins
0
Plant Preparations
0
amodiaquine, artesunate drug combination
0
Amodiaquine
220236ED28
Types de publication
Journal Article
Randomized Controlled Trial
Retracted Publication
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-56Subventions
Organisme : NCCIH NIH HHS
ID : R15 AT008277
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : RetractionIn
Informations de copyright
Copyright © 2018 Elsevier GmbH. All rights reserved.
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