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Ferroquine/artesunate effective against P. falciparum malaria
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Ferroquine combined with artesunate was effective, fast-acting and safely treated Plasmodium falciparum malaria in a recent study. Moreover, researchers said the combination therapy could reduce the burden of malaria in regions that have developed a resistance to other artesunate-based treatments.
“Ferroquine showed a promising efficacy and safety profile when given with artesunate and could therefore be regarded as a good partner for combination therapy,” Jana Held, PhD, of the German Centre for Infection Research at Heinrich Pette Institute in Hamburg, and colleagues wrote. “This would especially add a new treatment option for regions in which used artesunate-based combined therapies lose efficacy and are threatened by development of resistance.”
The researchers conducted a phase 2, randomized trial of ferroquine at eight African hospitals. The cohort (n = 326) of adults, adolescents and children presenting with P. falciparum was divided into a group that included children aged 2 to 13 years and a group that contained adults and adolescents. The researchers randomly divided and assigned three groups to 4 mg/kg artesunate with either 2 mg/kg ferroquine, 4 mg/kg ferroquine or 6 mg/kg ferroquine daily for 3 days. A fourth group was assigned 4 mg/kg ferroquine monotherapy daily for 3 days.
Malaria cure rates at day 28, based on PCR testing, were 99% for those assigned artesunate with either 6 mg/kg or 4 mg/kg ferroquine, and a 97% cure rate for participants assigned artesunate plus 2 mg/kg ferroquine. The cure rate for those assigned ferroquine only was 79%.
Adverse events were mild in both cohorts, with headache reported most commonly in the adult and adolescent cohort, and worsening P. falciparum in the child cohort.
“Further development plans are aimed at testing ferroquine in combination with other drugs, such as a synthetic endoperoxide, to establish the next generation of antimalarial combinations,” Held and colleagues wrote.
In a related editorial, Timothy N.C. Wells, PhD, ScD, chief scientific officer of Medicines for Malaria Venture, Geneva, Switzerland, and a colleague, suggested that ferroquine could be the future of antimalarial treatment.
“Ferroquine could … make an ideal partner for one of the newer molecules in the global malaria portfolio,” they wrote “At least four such new molecules with long half-lives are being tested in patients, which could provide mutual protection against resistance in a combination therapy. The choice of right partner and the best regimen are difficult decisions to make, but the good news from the patients’ perspective is that the chloroquine family has yielded a third-generation molecule, expanding our options in the fight against malaria.” – by David Costill
Disclosure: The study was funded by Sanofi. Held reports no relevant financial disclosures. Wells reports Medicines for Malaria Venture and Sanofi are exploring potential combination partners for ferroquine in clinical studies. Please see the full study for a list of all other authors’ relevant financial disclosures.
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