Patients with Ebola who were prescribed artensunate-amodiaquine had a lower mortality risk than those given artemether-lumefantrine, according to data recently published in The New England Journal of Medicine.

There have been 28,000 cases of the Ebola virus disease (EVD) in West Africa since the outbreak was declared in March 2014. The virus has claimed more than 11,000 lives, particularly in areas including Guinea, Sierra Leone, and Liberia, according to data in the study.

Malaria treatment has been recommended for patients with suspected EVD. An Ebola treatment center in Foya, Liberia used a first-line antimalarial combination drug artemether-lumefantrine, until the center ran out for a 12-day period in August 2014. During these 12 days, patients received artensunate-amodiaquine, which includes a compound with anti-Ebola virus activity. The researchers then calculated mortality risk ratios of each drug to compare the antimalarial treatments.


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The study included data from 382 patients with confirmed EVD who were admitted to the Ebola treatment center in Foya between June 5 and October 24, 2014. Researchers gave 194 patients artemether-lumefantrine and gave 71 patients artensunate-amodiaquine.

The mortality rate among the patients in the artemether-lumefantrine group was 64.4%, compared to the 50.7% mortality rate in the artensunate-amodiaquine group. In an adjusted analysis, the data showed that the artensunate-amodiaquine group had a 31% lower risk of mortality than the artemether-lumefantrine group (risk ratio (RR) 0.69; 95% confidence interval (CI), 0.54 to 0.89).

The researchers also noted that treatment with any antimalarial drug lowered the risk of death among the patients. Additional data from centers that use artemether-lumefantrine and have access to laboratory results and cardiac monitoring may be able to determine the safest and most effective dose against EVD.

 “We urge health care providers in countries affected by EVD to try to confirm these findings, including analyses of the effect of mass drug administration of artensunate-amodiaquine on EVD transmission in Sierra Leone and Liberia,” the authors concluded.

Reference

1. Gignoux E, Azman A, de Smet M, et al. Effect of Artesunate-Amodiaquine on Mortality Related to Ebola Virus Disease. N Eng J Med. 2016;374:23-32. doi: 10.1056/NEJMoa1504605.