Treatment Trials

SEAQUAMAT and AQUAMAT, two large scale trials:

In an effort to improve antimalarial treatment, MORU conducted the SEAQUAMAT (South East Asian Quinine Artesunate Malaria Trial) multicentre trial, operating in Bangladesh, Burma, India and Indonesia. SEAQUAMAT compared parenteral artesunate against quinine for the treatment of severe P. falciparum malaria. The study worked with 1,461 patients with severe malaria, mainly young adults, and demonstrated a survival benefit of 35% in favour of artesunate, decreasing the case fatality rate from 22.4% to 14.7%. The results of this study have directly led to a change in the WHO recommendations, and artesunate is now the first line treatment of severe malaria in adults including pregnant women.

In contrast with Asia, sub-Saharan Africa has much higher transmission rates of P. falciparum - with the majority of the world’s malaria deaths occurring there. Severe malaria in Africa is mainly a childhood disease and is estimated to be responsible for 20 per cent of deaths in African children under five years old. Childhood malaria has slightly different features to that found in adults, and the remarkable findings of the SEAQUAMAT trial in Asian adults cannot be directly translated to African children. Therefore MORU, in collaboration with African partners, has also undertaken a large study called “AQUAMAT” (Africa Quinine Artesunate Malaria Trial) which compared parenteral artesunate with quinine in paediatric cases of severe malaria in 11 study sites nine countries across sub-Saharan Africa. The results demonstrate that compared with quinine, artesunate reduced the mortality rate from 10.9% to 8.5%, a relative reduction of 22.5%. This finding is consistent with the findings of the earlier SEAQUAMAT study. You can read more about AQUAMAT here.