Propensity score analysis of artesunate versus quinine for severe imported Plasmodium falciparum malaria in France.

15 Mar 2019
Elket N, Kendjo E, Thellier M, Assoumou L, Potard V, Taieb A, Tantaoui I, Caumes E, Piarroux R, Roussel C, Buffet P, Costagliola D, Jaur├ęguiberry S, French Artesunate Working Group.

BACKGROUND

Little is known on the use of artesunate compared to quinine for the treatment of imported malaria cases in non-endemic countries with high level of care. Therefore, we compared the two treatments in terms of mortality, hospital and intensive care unit discharge rates.

METHODS

We analyzed the cohort of all severe imported malaria patients reported to the French National Reference Center from 2011 to 2017. After controlling for differences between quinine and artesunate treated individuals using the inverse probability of treatment weighting method, 28 day mortality rate was compared between the groups as well as hospital and ICU discharge rates using Kaplan Meier estimation and weighted Cox proportional hazard models.

RESULTS

Overall, 1544 patients were enrolled. Fifty patients died, 18 in the quinine group (n=460) and 32 in the artesunate group (n=1084) corresponding to death rates of 3.9% 2.9% respectively. No difference was evidenced between quinine and artesunate neither in mortality nor in hospital discharge rate with HR= 1.03, CI 95% [0.47-2.25] and HR= 1.12, CI 95% [0.94-1.34] respectively. Artesunate was associated with a faster ICU discharge rate, HR = 1.18, CI 95% [1.02-1.36].

CONCLUSIONS

In a country with a high level of care, artesunate was associated with a shorter length of stay in the ICU and this supports the actual therapeutic transition, however no difference was found neither in terms of mortality nor in hospital discharge rates between artesunate and quinine patients.