Safety and Effectiveness of Intravenous Artesunate for Treatment of Severe Malaria in the United States—April 2019 Through December 2020

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Abanyie, Francisca ; Acharya, Sushama D. ; Leavy, Isabelle ; Bowe, Meara ; Tan, Kathrine R.
• Description:
  Background. ; Severe malaria can be deadly and requires treatment with intravenous artesunate (IVAS). The Centers for Disease Control and Prevention provided IVAS starting 1 April 2019 for all patients with severe malaria in the United States. This study describes the safety and effectiveness of IVAS in these patients. ; Methods. ; Patients meeting criteria for severe malaria April 2019–December 2020 who received IVAS were included. Demographic, clinical, laboratory, adverse event, and outcome information were collected. Clinical presentation, time to reach 1% and 0% parasitemia, adverse events, and death were described using proportions, medians, interquartile range (IQR), and tests of significance for differences in proportions. ; Results. ; Of 280 patients included, the majority were male (61.4%), Black (75.0%), with a median age of 35 years (IQR: 15.8–53.9). Most had Plasmodium falciparum (83.6%) with median parasitemia of 8.0% (IQR: 4.6–13.2). Of 170 patients with information, 159 (93.5%) reached ≤1% parasitemia by the third IVAS dose with a median time of 17.6 hours (IQR: 10.8–28.8), and 0% parasitemia in a median of 37.2 hours (IQR 27.2–55.2). Patients with parasite densities >10% and those requiring adjunct therapy had significantly higher parasite clearance times. Adverse events associated with IVAS were reported in 4.8% (n = 13 of 271). Eight patients had post-artesunate delayed hemolysis that resolved. There were 5 (1.8%) deaths, all attributable to severe malaria. ; Conclusions. ; IVAS is a safe and effective drug for the treatment of severe malaria in the United States; timely administration can be lifesaving.
• Subjects:
  • Adolescent
  • Adult
  • Antimalarials
  • Artemisinins
  • Artesunate
  • Female
  • Humans
  • Malaria
  • Malaria, Falciparum
  • Male
  More +
• Keywords:
  • effectiveness
  • intravenous artesunate
  • safety
  • severe malaria
  • United States
• Source:
  Clin Infect Dis. 73(11):1965-1972
• Pubmed ID:
  34314501
• Pubmed Central ID:
  PMC10959111
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  73
• Issue:
  11
• Download URL:
  https://stacks.cdc.gov/view/cdc/153488/cdc_153488_DS1.pdf
• File Type:
  [PDF - 458.83 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:34ac9f56e82a7e18652af1814edea7d5bff06381bbe23bbe1cbddc30a05bee4c