Tackling drug resistance
One of the key reasons new tools will be needed to eradicate malaria is antimicrobial resistance. Several artemisinin-based combination therapies (ACTs), which are a first-line treatment for acute, uncomplicated malaria in approximately 80 countries, are now failing against Plasmodium falciparum in parts of South East Asia, and markers of partial artemisinin resistance have also been reported in Rwanda.1 If resistance to artemisinin or partner drugs were to take hold in sub-Saharan Africa, where the malaria burden is highest, it could lead to failure of the ACTs, which would pose a major threat to malaria control and elimination efforts. Over the last decade, MMV and partners have progressed a wide range of fixed-dose, 3-day ACTs through clinical development, with a focus on making them child-friendly and affordable.
Resistance to antimalarials can also result from incomplete cure. Current ACTs must be taken once or twice daily over a period of 3 days and several studies suggest that patients often do not complete the full course of treatment. MMV is working to shorten or simplify the treatment course, with medicines that also address emerging drug resistance. Such a combination should provide post-treatment protection for as long as possible and also reduce transmission. In the best case, it would be what is known as a single-exposure radical cure, administered as one or more doses in a single day, thus simplifying case management and helping to improve compliance.
Driving towards elimination and eradication
The availability of drugs that are easy to administer, can reduce malaria transmission and provide a meaningful duration of post-treatment protection, will accelerate the path to eradication. For this reason, compounds are also selected for their ability to block transmission and protect against malaria. In 2019, to accelerate the development and selection of new combination therapies, MMV launched the Malaria Drug Development Catalyst, a new legal and scientific platform that helps to identify the best combinations of compounds to take forward and allow for an ease of exchange between partners.
1. Tacoli C et al. "Artemisinin Resistance–Associated K13 Polymorphisms of Plasmodium falciparum in Southern Rwanda, 2010–2015." Am J Trop Med Hyg. 95(5): 1090–1093 (2016).