title: Efficacy and safety of artemether in the treatment of chronic fascioliasis in Egypt: exploratory phase-2 trials.
abstract: BACKGROUND
  Fascioliasis is an emerging zoonotic disease of considerable veterinary and public health importance. Triclabendazole is the only available drug for treatment. Laboratory studies have documented promising fasciocidal properties of the artemisinins (e.g., artemether).
  
  
  METHODS
  We carried out two exploratory phase-2 trials to assess the efficacy and safety of oral artemether administered at (i) 6×80 mg over 3 consecutive days, and (ii) 3×200 mg within 24 h in 36 Fasciola-infected individuals in Egypt. Efficacy was determined by cure rate (CR) and egg reduction rate (ERR) based on multiple Kato-Katz thick smears before and after drug administration. Patients who remained Fasciola-positive following artemether dosing were treated with single 10 mg/kg oral triclabendazole. In case of treatment failure, triclabendazole was re-administered at 20 mg/kg in two divided doses.
  
  
  RESULTS
  CRs achieved with 6×80 mg and 3×200 mg artemether were 35% and 6%, respectively. The corresponding ERRs were 63% and nil, respectively. Artemether was well tolerated. A high efficacy was observed with triclabendazole administered at 10 mg/kg (16 patients; CR: 67%, ERR: 94%) and 20 mg/kg (4 patients; CR: 75%, ERR: 96%).
  
  
  CONCLUSIONS
  Artemether, administered at malaria treatment regimens, shows no or only little effect against fascioliasis, and hence does not represent an alternative to triclabendazole. The role of artemether and other artemisinin derivatives as partner drug in combination chemotherapy remains to be elucidated.
authors: Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland. jennifer.keiser@unibas.ch
authors: Jennifer
authors: J
authors: Keiser
authors: Hanan
authors: H
authors: Sayed
authors: Maged
authors: M
authors: el-Ghanam
authors: Hoda
authors: H
authors: Sabry
authors: Saad
authors: S
authors: Anani
authors: Aly
authors: A
authors: el-Wakeel
authors: Christoph
authors: C
authors: Hatz
authors: Jürg
authors: J
authors: Utzinger
authors: Sayed Seif
authors: SS
authors: el-Din
authors: Walaa
authors: W
authors: el-Maadawy
authors: Sanaa
authors: S
authors: Botros
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000009:adverse effects*; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004534:Egypt; D005209:Fasciola / Q000187:drug effects / Q000302:isolation & purification; D005211:Fascioliasis / Q000188:drug therapy*; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010270:Parasite Egg Count; D010865:Pilot Projects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D037621:Artemisinins; D000077549:Artemether