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Injectable artesunate: cure or killer?

June 27, 2014 - 13:16 -- Irene Teis

A document in Scientific American (June 2014) describes the activities of MVV Medecines for Malaria Ventures, a « non profit » organization (association sans but lucratif) located at Geneva. It is surprising to learn that they sell Artesunate in monotherapy for intravenous injection at high doses ; in cooperation with WHO and Médecins sans Frontières.

Artemisinin derivatives not only lead to resistance, widespread in Africa now. N Van Hong and U. d’Alessandro in Emerging Infect Dis. Jul 2014 describe the case of a man with severe malaria who does not respond to intravenous artesunate. But these chemical derivatives also lead to strong side effects at high doses. Haemolytic, hepatotoxic, cytotoxic, neurotoxic, cardiotoxic, genotoxic, ototoxic, embryotoxic, spleenotoxic effects have been described in www.malariaworld.org on October 19 2013. A recent paper from Germany T Rolling et al., Malaria Journal2012, 11 :169) describes post-treatment haemolysis by intravenous artesunate for three patients with pararasitaemia. The effect appears 2-3 weeks after the treatment.

Several other research teams have seen strong evidence for the same haemolytic anemia caused by IV artesunate.

-   Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium . Annemarie R Kreeftmeijer-Vegter12*,Malaria Journal, 11:102 doi:10.1186/1475-2875-11-102, 2012.

-   Severe malaria, artesunate and haemolysis, Pietro Caramello, Journal of Antimicrobial Chemotherapy Volume 67, Issue 8 Pp. 2053-2054. 2012.

-   Artemisin-based combination therapies and their introduction in Japan, S Kano, Infect Chemother 16(6) : 375-382, 2010.

How is it possible that this product is still on the market ? An affected person in Germany will be recovered by the intense care described in the paper from T Rolling in Malaria Journal. But what about an African child returning home with his mother in the belief that the child has been cured ?

Why are African governments put under pressure not to use oral or rectal artesunate ? Why does WHO veto clinical trials with herbal medicinelike Artemisia afra ? Is it to protect this monopolistic business of injectable artesunate run by MMV, WHO and MSF ? As Wallace Peters said : » I dissipated much energy in my younger days to scrape up funds for my research teams. Today, if you open the right tap, money can flow like water… »

Comments

Submitted by Marc Vanacker (not verified) on

Further to the memberblog of Irene Teis, June 27, 2014 "Injectable artesunate, cure or killer" where several cases of haemolytic anemia are describeb in Belgium, Netherlands, Japan, Germany a paper published in Malaria Journal (2014, Oct 11:13) describes a similar case in France. An Ivoirian female developed severe haemolytic anemia after treatment with parenteral artesunate. Further investigations evidenced drug-induced antibodies related to artesunate. It was concluded a drug-mediated autoimmune haemolytic anemia.

Submitted by Marc Vanacker (not verified) on

Anemia similar to that noted in recent reports on imported malaria in Europe after IV artesunate treatment is also reported in France (M Danis et al., Bull Acad Nat Méd 3, 699-716, 2013). Artesunate is not licensed in Europe but has been available in France since May 2011 through patient program controlled by the French Agency for Drug Safety [ANSM]. The first 99 patients treated with artesunate up to September 2012 experienced satisfactory efficacy and tolerability. Delayed, sometimes persistent anemia was observed in 29% of the patients . This unexpected adverse effect requires further investigation. IV artesunate is now recommended as the first-line treatment for severe falciparum malaria in France.

This is close to the figure of 23 % reported for Belgium and Netherlands (A Kreeftmeijer et al., Malaria Journal, 2012, 11 :102) and to the average figure reported for Europe : 6 patients out of 25 travelers treated at 7 centers in Europe ( T. Zoller et al., Emerging Infectuous Diseases, 17, 5, 2011).

Who is going to stop this disaster !