Artesunate IND for malaria treatment in the United States

The world’s most potent antimalarial, artemisinin, is not available to physicians in the United States but a CDC investigational new drug (IND) project is trying to change that. Over 1,000 cases of malaria are imported into the United States every year and many cases present with severe complications as most travelers lack any natural immunity. CDC is making artesunate available for free through its Atlanta headquarters and CDC quarantine stations across the country for the treatment of severe malaria.

Artesunate is a water-soluble derivative of artemisinin which can be delivered orally or intravenously, though the later is the preferred route for severe cases. The standard treatment in the United States for severe malaria is IV quinidine (a quinine derivative) which has more side effects including hypoglycemia, necessitates cardiac monitoring, and is not carried by many hospital formularies. Jones et al. in a recent Cochrane review summarized the benefits of artesunate over quinine for the treatment of severe malaria (an additional ~40% reduction in mortality).

Dr. Phillip Rosenthal describes a case in the NEJM which would benefit from the IND and also provides a broader review of clinical aspects of artemisinin use. He notes artemether, a lipid soluble derivative of artemisinin, can suffer from varied absorption but its important to point out that artemether is invaluable in peripheral health facilities in developing countries where it can be delivered intramuscularly by minimally trained staff.

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