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Iron chelating agents for treating malaria.

H J Smith1, M Meremikwu

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

The Cochrane Database of Systematic Reviews
|June 14, 2003
PubMed
Summary
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Iron chelators show potential benefits for malaria treatment, with deferiprone speeding recovery and parasite clearance. However, more research is needed to confirm these findings and assess safety for Plasmodium falciparum malaria.

Area of Science:

  • Infectious Diseases
  • Pharmacology

Background:

  • Plasmodium falciparum malaria remains a significant global health concern, driving research into novel therapeutic strategies.
  • Iron chelation is being investigated as an adjunctive therapy to existing antimalarial regimens to reduce mortality.
  • Evaluating the impact of iron chelators on patient outcomes is crucial before widespread clinical adoption.

Purpose of the Study:

  • To evaluate the efficacy of iron-chelating agents, alone or combined with antimalarials, in treating Plasmodium falciparum malaria.
  • To assess the effects on mortality, coma recovery time, parasite clearance, and adverse events in adults and children.
  • To synthesize evidence from randomized controlled trials on iron chelators in malaria treatment.

Main Methods:

  • A systematic search of multiple databases (Cochrane, MEDLINE, EMBASE) and expert consultation was conducted up to January 2003.

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  • Included randomized controlled trials compared iron chelators with placebo or antimalarial treatment alone.
  • Data extraction and quality assessment were performed independently by two reviewers, with authors contacted for additional information.

    • Main Results:

    • Seven trials with 570 participants were analyzed. DFO (deferoxamine) showed no significant effect on mortality but reduced seizures, though with increased adverse effects.
    • Deferiprone, an oral iron chelator, significantly shortened coma recovery time and parasite clearance in a small trial, but clinical significance is uncertain.
    • Limited data exist, with non-significant trends suggesting potential harm (death) and benefit (seizures) with DFO, and possible benefits with deferiprone.

    Conclusions:

    • Insufficient data currently prevent definitive conclusions on the use of DFO or deferiprone for Plasmodium falciparum malaria.
    • Further large-scale trials are necessary to establish the clinical effectiveness and safety of iron chelators.
    • Future research should prioritize evaluating clinical outcomes and rigorously assessing adverse effects of iron-chelating agents in malaria treatment.