New Type of R&D Cooperation Spawns Malaria Drugs: Artemisinin-Based Combination Therapy Drugs (ACTs) Are the Most Effective Malaria Medicines to Date, but Many of the World's Poorest Countries Can Not Afford Them. Two ACTs That Are Due to Go on the Market This Year May Help to Fill the Gap

By Davidson, Clare | Bulletin of the World Health Organization, January 2006 | Go to article overview

New Type of R&D Cooperation Spawns Malaria Drugs: Artemisinin-Based Combination Therapy Drugs (ACTs) Are the Most Effective Malaria Medicines to Date, but Many of the World's Poorest Countries Can Not Afford Them. Two ACTs That Are Due to Go on the Market This Year May Help to Fill the Gap


Davidson, Clare, Bulletin of the World Health Organization


Artemisinin-based combination therapy drugs (ACTs) drugs are seen as a new way forward to treat malaria. But combining these medicines into a single tablet is often a challenge, and like most innovations is rarely tackled by scientists in developing countries.

Recently, however, a team from Brazil's Farmanguinhos, an institute of the Oswaldo Cruz Foundation (FIOCRUZ), solved the scientific puzzle of how to combine two anti-malarials, artesunate and mefloquine, into one tablet.

'Artesunate is a very tricky substance to work with," said Solange Wardell, coordinator of the Brazilian team, adding: "a slight increase in humidity could make artesunate decompose, thereby ceasing to be active." Wardell said it was essential that the combined drug be stable in tropical, humid climates where malaria is prevalent. It took a year of experiments to achieve that stability.

Brazil is one of several countries involved in a project run by a non-profit group Drugs for Neglected Diseases Initiative (DNDi) to develop fixed-dose artesunate-based combination medicines. Brazil's state-owned laboratory Farmanguinhos is perhaps best known for manufacturing generic versions of antiretroviral drugs that have helped to cut treatment costs for AIDS in developing countries.

As striking as Brazil's role was the participation of other unusual players in the project. Traditionally, research and development (R&D) in the pharmaceutical sector is done in developed countries; little innovation comes out of developing countries due to lack of funds, know-how and research-based pharmaceutical industries. This project based mainly on cooperation between developing countries marks a change. In addition to Brazil, Burkina Faso, Malaysia and Thailand were key players.

When Jean-Rend Kiechel, who held senior R&D management positions in the pharmaceutical industry, left the industry after three decades, he certainly broke the mould. "I heard about DNDi and was interested in the fact that it was trying to develop new drugs for neglected diseases. I felt I could contribute," said Kiechel, who subsequently became the project manager for the malaria medicines initiative.

Drug resistance is a major problem for treating malaria. In many parts of Africa single treatments for malaria, such as chloroquine, have lost their effectiveness because malaria parasites in humans' blood have become resistant to drugs designed to kill them. As a result, there is a huge demand for ACTs, drugs based on derivatives of artemisinin, a potent extract of the Arternesia annua plant.

No resistance to ACTs has been reported to date, but there is currently only one fixed-dose ACT combination on the market, Coartem, produced by Novartis. This product is on the WHO prequalification list of products recommended for purchase by UN and other agencies. WHO and UNICEF are making it available at US$ 2.4 per adult course of treatment, but for some countries even this is too expensive.

Every year Africa accounts for more than 60% of an estimated 350-500 million clinical cases of malaria globally, while children in Africa account for 80% of nearly one million malariarelated deaths worldwide according to WHO's Rollback Malaria department.

Many African countries have changed their national malaria treatment policy, switching from single to combination treatment. But the problem is that countries can not afford the new combination drugs, which are much more expensive than the old medicines.

Another problem is the laborious way medicines must be taken to treat malaria. Failure to stick to the exact dosages, taking one drug without the other or, as, often happens, not completing the course can reduce the effectiveness of the treatment.

Seeing the urgent need to develop a more effective and more affordable form of malaria treatment, Genevabased DNDi sought to develop two fixed-dose combinations each containing two d rugs in one tablet. …

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New Type of R&D Cooperation Spawns Malaria Drugs: Artemisinin-Based Combination Therapy Drugs (ACTs) Are the Most Effective Malaria Medicines to Date, but Many of the World's Poorest Countries Can Not Afford Them. Two ACTs That Are Due to Go on the Market This Year May Help to Fill the Gap
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