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Related Experiment Videos

Iron chelating agents for treating malaria.

H J Smith1, M Meremikwu

  • 1International Health Division, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, Merseyside, UK, L3 5QA. cjdhel@liv.ac.uk

The Cochrane Database of Systematic Reviews
|May 5, 2000
PubMed
Summary
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Iron chelators show no clear benefit for Plasmodium falciparum malaria mortality, but desferrioxamine may reduce seizures. Further research is needed to clarify potential harms and benefits of these adjunctive treatments.

Area of Science:

  • Malariology and Tropical Medicine
  • Pharmacology and Therapeutics

Background:

  • Plasmodium falciparum malaria continues to cause high mortality, with deaths and sequelae occurring even with antimalarial drug treatment.
  • Iron chelation is being investigated as an adjunctive therapy to reduce mortality in malaria patients.
  • The efficacy of iron chelators in improving patient outcomes requires thorough examination before widespread recommendation.

Purpose of the Study:

  • To evaluate the impact of iron-chelating agents, alone or with antimalarials, on Plasmodium falciparum malaria outcomes.
  • Key outcomes assessed include mortality, coma recovery time, parasite clearance, and adverse effects in adults and children.
  • The study aims to determine the safety and efficacy of iron chelators as adjuvant therapy.

Main Methods:

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  • Systematic electronic searches of major databases (Cochrane Library, MEDLINE, EMBASE) were conducted.
  • Randomized controlled trials involving adults and children with P. falciparum malaria were included.
  • Data extraction and meta-analysis were performed by two independent reviewers, calculating Relative Risk and 95% Confidence Intervals.

    • Main Results:

    • No significant evidence of benefit or harm regarding mortality was found, though some trials were small and one was stopped early due to increased deaths.
    • Desferrioxamine treatment was associated with a significantly lower risk of persistent seizures compared to placebo (RR 0.80, 95% CI 0.67 to 0.95).
    • However, desferrioxamine was linked to a higher incidence of various adverse effects.

    Conclusions:

    • This review indicates potential harm (increased mortality) and benefit (reduced seizures) associated with iron chelators in malaria treatment.
    • Data on coma recovery time and parasite clearance are still being clarified with trialists.
    • Future decisions on conducting further trials will depend on a careful assessment of the overall potential benefits versus risks.