Antimalarial drug combo cures 99% of children


By Shaoni Bhattacharya Using a combination of two malaria drugs could stave off an “impending malaria treatment crisis” in Africa, a new study indicates. Giving young children in Tanzania a six-dose course of artemether plus lumefantrine cleared the malarial parasite from the blood of 99% of patients after 14 days, showed the trial by led by researchers at the London School of Hygiene and Tropical Medicine, UK. This was far more effective than more conventional drugs or other combinations used in the study of about 1800 children, aged four months to 59 months. Although artemether-lumefantrine is already available and is recommended by many countries in Africa as a first-line treatment, there has been little data to show its real-life effectiveness. This is where patients are sent home to finish their treatment course, rather than being monitored in a controlled trial environment to ensure they take the right doses at the right time. “I think it’s very significant,” says Geoffrey Targett, a parasitologist at LSHTM and deputy director of the Gates Malaria Partnership, which funded the study. “It’s all very well doing clinical trials where you’ve got a great monitoring team, but that’s not real life at all. We know this combination works and now we know it works if you just pass it on with the right instructions to people who are sick.” A second trial, published alongside this study in a special malaria edition of The Lancet backs the combination’s effectiveness. This study, which included adults, showed the combination was 97% effective in children under five, and 98% effective overall. Although the combination appears promising in the face of growing drug resistance to antimalarial drugs in Africa, other factors may limit its uptake, says Targett. Cost is a major problem, with the combination being at least ten times more expensive than conventional antimalarial drugs like chloroquine, which is now virtually ineffective in Africa. Another problem is short supply – artemether is based on a highly-sought ingredient called artemisinin, derived from a traditional Chinese medicine herb known as sweet wormwood (Artemisia annua). And artemether and lumefantrine also have differing half-lives in the body, which could give the Plasmodium falciparum parasite – which causes malaria in Africa – a chance to undergo natural selection and potentially evolve resistance. Tackling malaria in Africa is a major issue, with the number of current cases standing at half a billion. An editorial in The Lancet also hit out at a major international initiative, Roll Back Malaria, for failing to deliver on its promises to combat the deadly disease. It says the 90-strong global alliance of organisations – such as the World Health Organization and UNICEF – has not only failed in its aims “but it may actually have caused harm”. It blames the alliance’s “loose association” structure, saying it “actually inhibited decision-making and limited accountability”, and calls for stronger leadership. “Without this commitment, the history of Roll Back Malaria will become a calamitous tale of missed opportunities, squandered funds, and wasted political will,” the journal warns. A third study in the issue shows that giving the drug sulphadoxine-pyrimethamine just three times – at the same time as routine childhood vaccinations – cut malaria in Tanzanian children by 59% in the first year of life, and the beneficial effects have so far lasted into their second year. However, a further article concludes that it will be at least a decade before a malaria vaccine will be ready for widespread use. Journal reference: The Lancet (vol 365,
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