Arteflene compared with mefloquine for treating Plasmodium falciparum malaria in children

Arteflene is a synthetic peroxide recently developed from an indication of antimalarial activity found in the Chinese plant Artabotrys uncinatus. The new antimalarial was compared against mefloquine in a phase 3, open-labeled, randomized trial in children with uncomplicated Plasmodium falciparum malaria in Gabon. Patients received single oral doses of either 25 mg/kg of arteflene suspension or 15 mg/kg of mefloquine tablets. High-grade (RII and RIII) resistance was observed in eight (40%) of the 20 patients receiving the single dose of arteflene, but in none of the 21 mefloquine-treated patients (P < 0.005). At day 28, only one patient in the arteflene group, compared with all 21 patients in the mefloquine group, was cured (P < 0.001). Arteflene cleared fever slightly but not significantly faster than mefloquine and the 50% and 90% parasite clearance times were comparable in both treatment groups. In vitro results in the arteflene group suggest an increase of arteflene resistance when comparing sensitivity of paired parasite isolates before treatment and at recrudescence. Both treatment regimens were well-tolerated. In conclusion, single dose monotherapy with arteflene was not effective in curing children suffering from uncomplicated P. falciparum malaria in Gabon, while mefloquine proved to be highly effective for this purpose.