Reappraising the cardiosafety of dihydroartemisinin-piperaquine

The arsenal of efficacious drugs for the treatment of malaria remains small and is clearly insufficient to tackle the global burden of malaria, with more than 216 million clinical episodes and nearly half a million deaths annually.1 Among the new antimalarials that have been developed in the past decade, the artemisinin-based combination dihydroartemisinin–piperaquine is one of the most promising, on account of its good efficacy and tolerability, simplified dose schedule (ie, once daily for 3 days), and long post-treatment prophylactic effect.2 The only brand of dihydroartemisinin–piperaquine that has been registered under stringent regulatory authority is Eurartesim (licensed by the European Medicines Agency [EMA] in 2011), although at least three other brands exist: Duo-cotecxin (also prequalified by WHO), D-ARTEPP, and Arterakine. Dihydroartemisinin–piperaquine is not only used as a treatment of uncomplicated malaria but also has been proposed as an alternative to sulphadoxine–pyrimethamine for intermittent preventive treatment of malaria during pregnancy,3 or as a suitable drug for the mass treatment of entire populations as part of malaria-elimination endeavours