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A Randomized Controlled Pilot Study of Artesunate versus Triclabendazole for Human Fascioliasis in Central Vietnam

Human fascioliasis caused by Fasciola hepatica or Fasciola gigantica is an increasing global problem. The mainstay of current treatment is triclabendazole, but resistance in animals has been described, and it is not available in many countries. The antimalarial artesunate has an excellent safety profile, and there is increasing evidence of its efficacy against other parasites both in vitro and in vivo. We performed a study to investigate the usefulness of artesunate in symptomatic human fascioliasis; 100 patients were enrolled. Patients treated with artesunate were significantly more likely to be free of abdominal pain at hospital discharge (50/50 versus 44/50, P = 0.027, relative risk 1.14, 95% confidence interval 1.03–1.26), but the complete response rate at 3 months was lower than for patients treated with triclabendazole (38/50 versus 46/50, P = 0.05, RR 0.83, 95% CI 0.69–0.98, artesunate versus triclabendazole). There may be a role for artesunate in fascioliasis.

Received September 4, 2007. Accepted for publication December 13, 2007.

Financial support: The study was funded by the Wellcome Trust, United Kingdom. Triclabendazole (Egaten) was provided free as an unrestricted gift from Novartis International AG, Basel, Switzerland.

Disclaimer: The supporting bodies had no role in study design, running of the trial, result collection, analysis, or authorship of this work.

^* Address correspondence to Jeremy N. Day, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. E-mail: jday{at}oucru.org

Authors’ addresses: Tran Tinh Hien, Ng Thanh Truong, Nguyen Thi Dung, Nguyen Thi Hue, and Tran Kim Dung, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam. Nguyen Hoang Minh and Hoang Dinh Dat, Binh Dinh Provincial Hospital, Qui Nhon City, Vietnam. Phung Quoc Tuan, James I. Campbell, Jeremy J. Farrar, and Jeremy N. Day, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam, Telephone: +84 8923 7954, Fax: +84 8923 8904, E-mail: jday{at}oucru.org.

Reprint requests: Jeremy N. Day, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam, Telephone: +84 8923 7954, Fax: +84 8923 8904, E-mail: jday{at}oucru.org.