Neuroauditory Toxicity of Artemisinin Combination Therapies—Have Safety Concerns Been Addressed?

Ramos Martin, Virginia, Gonzalez, Carmen, Mackenzie, Ian, Schmutzhard, Joachim, Pace, Cheryl, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 and Terlouw, Anja ORCID: https://orcid.org/0000-0001-5327-8995 (2014) 'Neuroauditory Toxicity of Artemisinin Combination Therapies—Have Safety Concerns Been Addressed?'. American Journal of Tropical Medicine and Hygiene, Vol 91, Issue 1, pp. 62-73.

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Abstract

Although artemisinin-based combination therapies (ACTs) are widely viewed as safe drugs with a wide therapeutic dose range, concerns about neuroauditory safety of artemisinins arose during their development. A decade ago, reviews of human data suggested a potential neuro-ototoxic effect, but the validity of these findings was questioned. With 5–10 years of programmatic use, emerging artemisinin-tolerant falciparum malaria in southeast Asia, and the first calls to consider an increased dose of artemisinins, we review neuroauditory safety data on ACTs to treat uncomplicated falciparum malaria. Fifteen studies reported a neurological or auditory assessment. The large heterogeneity of neuro-ototoxic end points and assessment methodologies and the descriptive nature of assessments hampered a formal meta-analysis and definitive conclusions, but they highlight the persistent lack of data from young children. This subgroup is potentially most vulnerable to any neuroauditory toxicity because of their development stage, increased malaria susceptibility, and repeated ACT exposure in settings lacking robust safety monitoring.

Item Type:	Article
Subjects:	QV Pharmacology > QV 56 Adverse effects (General) QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 256 Antimalarials QX Parasitology > Protozoa > QX 135 Plasmodia WC Communicable Diseases > Tropical and Parasitic Diseases > WC 770 Therapy WL Nervous System > WL 100 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.4269/ajtmh.13-0702
Depositing User:	Helen Wong
Date Deposited:	04 Jul 2014 09:52
Last Modified:	13 Sep 2019 13:10
URI:	https://archive.lstmed.ac.uk/id/eprint/3749

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