Artemisinins and synthetic trioxolanes in the treatment of helminth infections

Purpose of review Helminthiases, including schistosomiasis and food-borne trematodiasis, affect millions of people. Just a few drugs are used for the treatment and control of these diseases. We review recent in-vitro and in-vivo observations with the artemisinins and synthetic trioxolanes against major trematode infections, update clinical findings, and discuss the potential impact that artemisinin-based combination therapy might have on trematode infections in settings where malaria and helminthiases are co-endemic. Recent findings The artemisinins and synthetic trioxolanes possess a broad spectrum of activity against trematodes. High worm-burden reductions were obtained with these drugs in rodents with acute or chronic infections of Schistosoma japonicum, S. mansoni, Clonorchis sinensis, Fasciola hepatica and Opisthorchis viverrini. Clinical trials carried out in Africa, utilizing artemether or artesunate singly or as artemisinin-based combination therapies, following recommended malaria treatment schedules, found an effect against schistosomiasis. Summary Artemisinin-based combination therapies are increasingly deployed against malaria, and hence there is a need to assess the potential auxiliary effects against schistosomiasis in settings where both diseases are endemic. Also, the effect of artemisinin-based combination therapies on food-borne trematodiasis should be assessed. In-vitro and in-vivo findings with the synthetic trioxolanes provide data to launch preclinical investigations.