In the absence of resistance, ACTs are effective drugs. However, with emerging resistance to the above currently recommended ACTs, it is necessary to identify new drug combinations with equivalent efficacy. The latest findings concluded that pyronaridine?artesunate performed well in these trials compared to artemether?lumefantrine and mefloquine plus artesunate. The review recommended further efficacy and safety studies in African and Asian children to clarify whether the combination is an option for first?line treatment of uncomplicated P falciparum malaria.

Following this review, the latest edition of the WHO guidelines for the treatment of malaria did not recommend pyronaridine?artesunate for general use. The Guideline Development Group recommended further data were required for efficacy in children less than five years of age, and safety, including safety of repeat dosing. They noted the undesirable effects of elevated liver function tests. Since the previous update and WHO Guidelines, the West African Network for Clinical Trials of Antimalarial Drugs has published a new study of pyronaridine?artesunate and the European Medicines Agency (EMA) has adopted a positive scientific opinion of pyronaridine?artesunate.

No evidence that liver injury was severe or irreversible

The World Health Organization (WHO) recommends ACTs to treat uncomplicated Plasmodium falciparum (P. falciparum) malaria. However, concerns over rising artemisinin resistance have led global initiatives to develop new partner drugs to protect their efficacy. In this update, independent authors Joseph Pryce and Paul Hine at LSTM assessed the efficacy of pyronaridine-artesunate in treating malaria. They found that the treatment was as good, if not better than other ACTs; and while some people receiving it have liver function tests suggesting mild liver injuries, there was no evidence that this injury was severe or irreversible.

LSTM's Dr. Hine is corresponding author on the review. He said: "The need to find novel ACTs is important so that we can protect the efficacy of the artemisinin derivatives within them. The evidence that we found clearly showed at pyronaridine-artesunate performs as well, if not better than some of the currently marketed ACTs." The review team looked at the results from 10 included trials that compared pyronaridine-artesunate with other currently-used treatments for P. falciparum malaria.

Five of the studies looked specifically at the safety of the drug, and two of the trials exclusively recruited children under the age of 12. Joe Pryce, one of the authors, said: "We found that pyronaridine-artesunate did increase the risk of having blood tests that showed mild liver injury, but there was no evidence that this caused severe or irreversible damage. The findings of this review's efficacy analysis support the recommendation for using pyronaridine-artesunate in areas of multiple drug resistance, providing effective malaria treatment where other treatments may be failing."