Safety and Efficacy of Adjunctive Therapy With Artesunate in the Treatment of Severe Malaria: A Systematic Review and Meta-Analysis

• Main Authors: Yuanyuan Zou, Fei Tuo, Zhiqi Zhang, Jiawen Guo, Yueming Yuan, Hongying Zhang, Zhiyong Xu, Ziyi Pan, Yexiao Tang, Changsheng Deng, Nadia Julie, Wanting Wu, Wenfeng Guo, Changqing Li, Xinan Huang, Qin Xu, Jianping Song, Qi Wang
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-11-01
• Series: Frontiers in Pharmacology
• Subjects: meta-analysis; severe malaria; systematic review; safety; efficacy; artesunate
• Online Access: https://www.frontiersin.org/articles/10.3389/fphar.2020.596697/full

Objective: The purpose of this meta-analysis of longitudinal studies is to determine the safety and efficacy of artesunate combined with other forms of adjunctive therapies for severe malaria.Methods: Following the PRISMA guidelines, we searched multiple databases with the search terms “artesunate” and “adjunctive therapy” and “severe malaria” in July 2020. If the search showed a randomized controlled trial, the study was included in this meta-analysis. The random-effects model was used to calculate the combined incidence rate and relative risk or risk difference.Results: This meta-analysis included nine longitudinal studies with 724 participants. We found that the mortality rates in the artesunate monotherapy group and the artesunate + adjuvant therapy group are similar (RD = −0.02, 95% confidence interval: −0.06–0.02). The incidence of adverse reactions in the artesunate monotherapy group and the artesunate + adjuvant therapy group was also similar.Conclusion: No significant differences in safety and efficacy were observed between the artesunate monotherapy group and the artesunate + adjuvant therapy group. Higher quality and rigorously designed randomized controlled studies are needed to validate our findings.