Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria
Identifieur interne : 000785 ( Istex/Curation ); précédent : 000784; suivant : 000786Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria
Auteurs : Philip E. Thuma [États-Unis] ; George F. Mabeza [Zambie] ; Godfrey Biemba [Zambie] ; G. J. Bhat [Zambie] ; Christine E. Mclaren [États-Unis] ; Victor M. Moyo [États-Unis] ; Stenford Zulu [Zambie] ; Hlosukwazi Khumalo [Zambie] ; Patricia Mabeza [Zambie] ; Abraham M'Hango [Zambie] ; Dean Parry [Zambie] ; Anton A. Poltera [Suisse] ; Gary M. Brittenham [États-Unis] ; Victor R. Gordeuk [États-Unis]Source :
- Transactions of The Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 1998-04.
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- KwdEn :
Abstract
To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% (32/175) in the deferoxamine group and 10·7% (19/177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% (18/117) with deferoxamine compared to 12·7% (15/118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% (14/58) with deferoxamine and 6·8% (4/59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.
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DOI: 10.1016/S0035-9203(98)90753-2
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>chemotherapy</term>
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<front><div type="abstract">To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% (32/175) in the deferoxamine group and 10·7% (19/177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% (18/117) with deferoxamine compared to 12·7% (15/118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% (14/58) with deferoxamine and 6·8% (4/59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.</div>
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