Randomised trial of pyronaridine versus chloroquine for acute uncomplicated falciparum malaria in Africa

Abstract

Background: The spread of chloroquine resistance poses a serious problem in Africa, where falciparum malaria transmission is the highest in the world. Pyronaridine, an acridine derivative, has been used successfully to treat malaria in China for over 20 years. We compared the efficacy of pyronaridine and chloroquine in African adult patients with acute uncomplicated falciparum malaria in Yaoundé, Cameroon, where chloroquine resistance is well established.

Methods: 96 patients were randomly assigned treatment with chloroquine 25 mg/kg or pyronaridine 32 mg/kg, both orally and divided over 3 days. Patients were followed up for at least 14 days on an outpatient basis. Analysis was by on-active-treatment.

Findings: After losses from follow-up (11) or because of self-medication with quinine (four), 41 patients treated with chloroquine and 40 treated with pyronaridine were analysed. Parasite clearance during the 14-day follow-up with chloroquine and pyronaridine was 44% and 100%, respectively. All patients treated with pyronaridine were afebrile by day 3, and parasitaemia cleared by day 4. No serious drug-related side-effects were noted in pyronaridine-treated patients.

Interpretation: Pyronaridine was rapidly effective and well-tolerated in African patients with acute, uncomplicated falciparum malaria and may represent an alternative drug against chloroquine-resistant malaria.

PIP: The spread of chloroquine resistance is a major problem in Africa, where falciparum malaria transmission is the highest in the world. Pyronaridine is an acridine derivative which has been used successfully to treat malaria in China for more than 20 years. The efficacy of pyronaridine and chloroquine is compared in African adult patients with acute uncomplicated falciparum malaria in Yaounde, Cameroon, where chloroquine resistance is well-established. 96 patients were randomly assigned treatment with chloroquine 25 mg/kg or pyronaridine 32 mg/kg, both orally and divided over 3 days. The subjects were followed for at least 14 days on an outpatient basis. Analysis was by on-active-treatment. 11 patients were lost to follow-up and 4 self-medicated with quinine. The remaining 41 patients treated with chloroquine and 40 treated with pyronaridine were analyzed. Parasite clearance during the follow-up period with chloroquine and pyronaridine was 44% and 100%, respectively. All patients treated with pyronaridine were afebrile by day 3, with parasitemia cleared by day 4. No serious drug-related side-effects were noted in pyronaridine-treated patients. It may be concluded that pyronaridine was rapidly effective and well-tolerated in African patients with acute, uncomplicated falciparum malaria and that it could prove to be an alternative drug against chloroquine-resistant malaria.