Summary

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• Artesunate (artesunate) is indicated for the initial treatment of severe malaria in adult and pediatric patients. Treatment of severe malaria with Artesunate for Injection should always be followed by a complete treatment course of an appropriate oral antimalarial regimen.
• This summary is based on the review of nine systematic review(s)/meta-analysis(es). ^[1-9]
• Primaquine + Artesunate-based Combination Therapies: High total dose primaquine (approximately 7 mg/kg) reduced P. vivax recurrence rates to 8.1%, compared to 19.3% with a low dose (approximately 3.5 mg/kg) and 51.0% without primaquine.
• Artesunate-Mefloquine (ASMQ): Although ASMQ remains effective for treating uncomplicated P. falciparum malaria, studies with failure rates exceeding 10% indicate a reduction in efficacy in certain locations.
• Intermittent Preventive Treatment in Infants (IPTi): IPTi with sulfadoxine-pyrimethamine (SP) reduced clinical malaria incidence by 30%, though the efficacy of SP declined over time.
• Primaquine + Artesunate-based Combination Therapies: Increased gastrointestinal symptoms were observed with higher daily doses of primaquine, with 10.9% of patients on a high daily dose reporting symptoms compared to 4.0% with no primaquine.
• Artesunate-Mefloquine (ASMQ): Serious adverse effects were infrequent, including seizures, encephalopathy, and cardiac arrhythmia. Local considerations are important, though no significant overall safety concerns were noted.
• Pyronaridine-Artesunate: There was high-certainty evidence of increased alanine aminotransferase (ALT) levels (> 5x ULN), with one instance of moderate drug-induced liver injury reported. Fewer ECG abnormalities were noted compared to other antimalarials.
• Artesunate Monotherapy vs. Artesunate + Adjunctive Therapy: No significant differences in the incidence of adverse reactions were observed between monotherapy and combination therapy groups.
• Substantial reductions in uncomplicated and severe malaria were observed in children under 5 years and older than 5 years in studies on Seasonal Malaria Chemoprevention (SMC) and Intermittent Preventive Treatment in infants (IPTi). Patients with G6PD deficiency, particularly those with 30% to less than 70% G6PD activity, experienced significant haemoglobin reduction when treated with Primaquine + Artesunate-based combination therapies. Elevated ALT levels were notably associated with Pyronaridine-Artesunate use, indicating a potential risk of liver injury in this subgroup.