Multiple First-line Therapies are the Best Way to Beat Malaria: Study

by VR Sreeraman on Sep 7 2008 10:31 AM

Scientists suggest that the best way to treat malaria is to avoid using same drug for everyone, and opt for multiple first-line therapies.

With the help of a computer model, a research team from Princeton University and Resources for the Future has found that many governments worldwide are recommending the wrong kind of malaria treatment.

Despite the availability of many drugs many countries have been recommend using what is known as a single first-line therapy- that is, using one drug repeatedly with many patients.

Lead researcher Maciej Boni said that countries could cut the death rate and forestall the development of drug resistance if a variety of different drugs were distributed to patients.

This approach, known as multiple first-line therapies or MFT, can be usey making sure different drugs cost about the same, so that patients would not be forced into buying the cheapest available drug.

"What we found is that using multiple first-line therapies is the best way to avoid treatment failures and to delay the development of resistance for as long as possible," said Boni, who recently has joined the staff of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam.

Boni, a mathematician and an evolutionary biologist, along with co-authors, Ramanan Laxminarayan and David Smith, designed a computer model with inputs based on more than 100 years of malaria field research.

They simulated dozens of treatment paths for a malaria outbreak among patients contrasting many variations of the status quo strategy of using a single first-line therapy with one employing MFT.

They found that there were major benefits to employing an MFT strategy, namely, fewer cases of malaria, fewer unsuccessful drug treatments, and a very significant delay in the onset of drug resistance in the parasites.

However, the researchers suggested that multiple effective therapies may not always be available. In some African countries where drug-resistance is already widespread, the only effective therapies are a class of drugs known as artemisinin-based combination therapies (ACTs).

"MFT does not necessarily solve all our problems," said Boni. "Antimalarial drug development needs to continue with the hope of producing novel and highly effective antimalarials that can be deployed alongside ACTs."

The study appears in Proceedings of the National Academy of Sciences.