Comparative pharmacokinetics and effect kinetics of orally administered artesunate in healthy volunteers and patients with uncomplicated falciparum malaria

The single-dose pharmacokinetics of 100 mg of orally administered artesunate (AS) were studied in 6 patient volunteers with uncomplicated falciparum malaria and in 6 healthy volunteers. Plasma concentrations of both the parent drug, AS, and its major metabolite, dihydroartemisinin (DHA), were measured simultaneously by high-performance liquid chromatography (HPLC) with electrochemical detection (ECD). The antimalarial activity of each plasma sample measured by an in vitro bioassay (BA) was used to derive activity concentrations. Artesunate was absorbed rapidly and then almost completely hydrolyzed to DHA in patients, whereas hydrolysis was incomplete in healthy volunteers. The mean +/- standard deviation (SD) maximum concentration (C-max) of AS was 296 +/- 110 nmol/L, the time to peak blood level (t(max)) was 0.71 +/- 0.66 hr, the half-life (t(1/2,z)) was 0.41 +/- 0.34 hr, and the bioavailability over 12 hr (area under the curve [AUC]((0-12))) was 253 +/- 185 nmol hr/L. Measured by HPLC, the C-max and AUC((0-12)) values of DHA in patients with malaria were significantly greater than in volunteers (1,948 +/- 772 and 1,192 +/- 315 nmol/L; 4,024 +/- 1,585 and 1,763 +/- 607 nmol hr/L, respectively; P less than or equal to 0.05). These differences were even greater when measured by BA. The C-max for patients with malaria was 2,894 +/- 2,497 and 795 +/- 455 nmol/L for volunteers, and AUC((0-12)) was 5,970 +/- 3,625 and 1,307 +/- 391 nmol hr/L, respectively (P less than or equal to 0.05). In contrast, DHA parameter estimates for t(1/2,z) and t(max) were similar between patients and healthy volunteers, with values of 0.80 +/- 0.30 versus 0.87 +/- 0.06 hr and 1.50 +/- 0.55 versus 1.13 +/- 0.52 hr, respectively (P > 0.5). Both drug metabolism and tissue protein binding could contribute to the differences between the antimalarial activity of artemisinin drugs in healthy volunteers and malaria infected patients.