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Clinical Pharmacology of Artemisinin-Based Combination Therapies

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Abstract

Malaria, a disease transmitted by the female Anopheles mosquito, has had devastating effects on human populations for more than 4000 years. Treatment of the disease with single drugs, such as chloroquine, sulfadoxine/pyrimethamine or mefloquine, has led to the emergence of resistant Plasmodium falciparum parasites that lead to the most severe form of the illness. Artemisinin-based combination therapies are currently recommended by WHO for the treatment of uncomplicated P. falciparum malaria. Artemisinin and semisynthetic derivatives, including artesunate, artemether and dihydroartemisinin, are short-acting antimalarial agents that kill parasites more rapidly than conventional antimalarials, and are active against both the sexual and asexual stages of the parasite cycle. Artemisinin fever clearance time is shortened to 32 hours as compared with 2–3 days with older agents. To delay or prevent emergence of resistance, artemisinins are combined with one of several longer-acting drugs — amodiaquine, mefloquine, sulfadoxine/pyrimethamine or lumefantrine — which permit elimination of the residual malarial parasites.

The clinical pharmacology of artemisinin-based combination therapies is highly complex. The short-acting artemisinins and their long-acting counterparts are metabolized and/or inhibit/induce cytochrome P450 enzymes, and may thus participate in drug-drug interactions with multiple drugs on the market. Alterations in antimalarial drug plasma concentrations may lead to either suboptimal efficacy or drug toxicity and may compromise treatment.

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  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

Dr German is the recipient of grant no. P30 AI27763 from the National Institutes of Health, University of California San Francisco-Gladstone Institute of Virology & Immunology Center for AIDS Research.

The authors thank Dr Grant Dorsey for his invaluable comments in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Drug Research Unit, University of California, San Francisco, 521 Parnassus Avenue, San Francisco, California, 94143-0622, USA

    Francesca T. Aweeka & Polina I. German

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Aweeka, F.T., German, P.I. Clinical Pharmacology of Artemisinin-Based Combination Therapies. Clin Pharmacokinet 47, 91–102 (2008). https://doi.org/10.2165/00003088-200847020-00002

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