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Preventing antimalarial drug resistance with triple artemisinin-based combination therapies

Author

Listed:
  • Tran Dang Nguyen

    (Pennsylvania State University)

  • Bo Gao

    (University of Oxford)

  • Chanaki Amaratunga

    (University of Oxford
    Mahidol University)

  • Mehul Dhorda

    (University of Oxford
    Mahidol University)

  • Thu Nguyen-Anh Tran

    (Pennsylvania State University)

  • Nicholas J. White

    (University of Oxford
    Mahidol University)

  • Arjen M. Dondorp

    (University of Oxford
    Mahidol University)

  • Maciej F. Boni

    (Pennsylvania State University
    University of Oxford)

  • Ricardo Aguas

    (University of Oxford
    Mahidol University)

Abstract

Increasing levels of artemisinin and partner drug resistance threaten malaria control and elimination globally. Triple artemisinin-based combination therapies (TACTs) which combine artemisinin derivatives with two partner drugs are efficacious and well tolerated in clinical trials, including in areas of multidrug-resistant malaria. Whether early TACT adoption could delay the emergence and spread of antimalarial drug resistance is a question of vital importance. Using two independent individual-based models of Plasmodium falciparum epidemiology and evolution, we evaluated whether introduction of either artesunate-mefloquine-piperaquine or artemether-lumefantrine-amodiaquine resulted in lower long-term artemisinin-resistance levels and treatment failure rates compared with continued ACT use. We show that introduction of TACTs could significantly delay the emergence and spread of artemisinin resistance and treatment failure, extending the useful therapeutic life of current antimalarial drugs, and improving the chances of malaria elimination. We conclude that immediate introduction of TACTs should be considered by policy makers in areas of emerging artemisinin resistance.

Suggested Citation

  • Tran Dang Nguyen & Bo Gao & Chanaki Amaratunga & Mehul Dhorda & Thu Nguyen-Anh Tran & Nicholas J. White & Arjen M. Dondorp & Maciej F. Boni & Ricardo Aguas, 2023. "Preventing antimalarial drug resistance with triple artemisinin-based combination therapies," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    • Handle: RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-39914-3
    DOI: 10.1038/s41467-023-39914-3
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    References listed on IDEAS

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    1. M. Isabel Veiga & Satish K. Dhingra & Philipp P. Henrich & Judith Straimer & Nina Gnädig & Anne-Catrin Uhlemann & Rowena E. Martin & Adele M. Lehane & David A. Fidock, 2016. "Globally prevalent PfMDR1 mutations modulate Plasmodium falciparum susceptibility to artemisinin-based combination therapies," Nature Communications, Nature, vol. 7(1), pages 1-12, September.
    2. Frédéric Ariey & Benoit Witkowski & Chanaki Amaratunga & Johann Beghain & Anne-Claire Langlois & Nimol Khim & Saorin Kim & Valentine Duru & Christiane Bouchier & Laurence Ma & Pharath Lim & Rithea Lea, 2014. "A molecular marker of artemisinin-resistant Plasmodium falciparum malaria," Nature, Nature, vol. 505(7481), pages 50-55, January.
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