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Friday 20th April 2018

Multi-drug strategy best for malaria

29th September 2008

Studies have confirmed once more that a variety of malaria treatments is better than monotherapies for beating resistance and cutting deaths.


A range of therapies should be used rather than a single first-line therapy, which can take years to switch away from.

Researchers writing in the Proceedings of the National Academy of Sciences reported using a computer model to simulate how using multiple first-line therapies (MFT) alongside each other would work within large populations.

The MFT approach showed significant advantages over using single therapies, according to study lead author and Princeton University researcher Maciej Boni.

With multiple therapies it is difficult for the malaria parasite to evolve resistance as it is transmitted from person to person because it encounters a different drug every time.

Parasites still develop rapid resistance to single drugs given for a limited time, an approach known as drug-cycling often used by developing world governments.

When single-line therapies fail, it can take years to switch over to the new drug and people continue using drugs that are ineffective in the meantime, further educating the parasite.

First line therapies might have a shelf-life of 5-20 years, but it was hard to know when to start the switch, Boni said.

The study found that using an MFT strategy could result in a 2.5 to three-fold increase in the amount of time a single drug could be used.

This would slash costly surveillance methods for drug resistance, too.

Under MFT, the approach could be to have different clinics give different drugs to different people, although such a strategy could pose ethical problems if some drugs were more effective than others, and difficulty explaining clinical decisions to patients.

Another approach would be to subsidise new drugs, including the newly developed artemisinin-based combination therapies (ACTs), so as to make all antimalarials the same price and allow patients to choose their drug.

Tanzania has already carried out such a strategy for ACTs in two of its districts, with funding from the Clinton Foundation.

The subsidy programme has displaced other, less effective therapies, making ACTs more widely available.

Experts cite difficulties with implementing the multi-drug approach, and challenges with monitoring its execution.

World leaders and philanthropists recently pledged nearly US$3 billion (£1.6 billion) to fight malaria, in the hope of eradicating the killer disease by 2015.

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