Effect of Artesunate-Amodiaquine on Mortality Related to Ebola Virus Disease
Effect of Artesunate-Amodiaquine on Mortality Related to Ebola Virus Disease
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DOI：
10.1056/nejmoa1504605
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发表时间：
2016-01-07
影响因子：
158.5
通讯作者：
Ciglenecki, Iza
中科院分区：
文献类型：
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作者：
Gignoux, Etienne;Azman, Andrew S.;Ciglenecki, Iza
背景建议对西非疑似埃博拉病毒病(EVD)的患者进行疟疾治疗，无论是系统性的还是基于确诊的疟疾诊断。在利比里亚洛法县福亚的埃博拉治疗中心，一线抗疟疾联合药物蒿甲醚-鲁米芬的供应于2014年8月耗尽，为期12天。在此期间，患者接受了青蒿琥酯-阿莫地喹的联合药物治疗；阿莫地喹是一种具有体外抗埃博拉病毒活性的化合物。在此期间，患者的护理没有发生其他明显的变化。方法我们将未经调整和调整的回归模型与标准化的患者水平数据进行拟合，以估计服用青蒿琥酯-阿莫地奎组(青蒿琥酯-阿莫地奎组)的确诊EVD患者与服用蒿甲醚-卢米芬三组(蒿甲醚-鲁米芬净组)和未开任何抗疟疾药物的患者(非抗疟药组)相比的死亡风险比。入院时，194名患者服用蒿甲醚-鲁米芬，71名患者服用青蒿琥酯-阿莫地喹。青蒿琥酯-阿莫地奎组的患者特征与蒿甲醚-鲁米芬碱组和非抗疟药组相似。蒿甲醚-鲁米芬碱组194名患者中共有125人死亡(64.4%)，而青蒿琥酯-阿莫地奎组71名患者中有36名死亡(50.7%)。在调整后的分析中，青蒿琥酯-阿莫地奎组的死亡风险比蒿甲醚-鲁米芬组低31%(风险比0.69；95%可信区间0.54-0.89)，在没有疟疾的患者中观察到更强的效果。结论服用青蒿琥酯-阿莫地喹的患者死于EVD的风险低于服用蒿甲醚-鲁米芬的患者。然而，我们的分析不能排除这样一种可能性，即蒿甲醚-鲁米芬与死亡风险增加有关，或者青蒿琥酯-阿莫地喹的使用与直接改变死亡风险的未测量的患者特征有关。
BACKGROUNDMalaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systematically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether-lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate-amodiaquine; amodiaquine is a compound with anti-Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.METHODSWe fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate-amodiaquine (artesunate-amodiaquine group), as compared with those who were prescribed artemether-lumefantrine (artemether-lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).RESULTSBetween June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether-lumefantrine and 71 were prescribed artesunate-amodiaquine. The characteristics of the patients in the artesunate-amodiaquine group were similar to those in the artemether-lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether-lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate-amodiaquine group (50.7%). In adjusted analyses, the artesunate-amodiaquine group had a 31% lower risk of death than the artemether-lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.CONCLUSIONSPatients who were prescribed artesunate-amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether-lumefantrine. However, our analyses cannot exclude the possibility that artemether-lumefantrine is associated with an increased risk of death or that the use of artesunate-amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.