Artemisinins are still the most powerful weapon against malaria, experts say

The powerful drugs known as artemisinins have a lot of weight in the global fight against malaria, and concerns about partial resistance have been exaggerated.

This is the message in an opinion piece published by scientists and doctors coinciding with World Malaria Day.

Professor Sanjeev Krishna of St George & s, University of London, collaborated with the Chinese scientist and Nobel Laureate Tu Youyou, who had discovered artemisinin in 1977, and other colleagues from the Perspective piece from the New England Journal of Medicine.

Artemisinin and its derivatives are known for their ability to rapidly reduce the number of parasites in the blood of malaria patients and have saved millions of lives around the world. WHO recommends artemisinin-based combination therapies, or ACTs, as the first- and second-line treatment for both uncomplicated malaria and chloroquine-resistant malaria.

"Partial resistance to artemisinin" has been confirmed in some countries of the Greater Mekong subregion, including Cambodia, Myanmar, Thailand and Vietnam. Researchers working in the region have expressed concerns about resistance to artemisinin and have required a response from WHO last year.

In their article, Professor Krishna and Tu Youyou point out that partial resistance to artemisinin delays the elimination of malaria parasites in the bloodstream as a result of an badociation treatment. Since parasite resistance only affects one of the stages of the parasitic cycle of malaria in man – the "ring" stage, this resistance can be overcome by using the correct artesunate baday, for example during 7 to 10 days rather than three days. If used, artemisinins will be effective even when early clearance of parasites is delayed.

The authors also note that treatment failures with ACTs can often be directly attributed to the partner drug and that it can be remedied by modifying the partner drug. Thus, for example, mefloquine plus artesunate can be switched to DHA with piperaquine in case of failure of the first.

Finally, say the authors, a new generation of antimalarials, which compares favorably with artemisinins in terms of activity, safety and the risk of resistance, should not appear very soon.

Professor Krishna said, "It is still possible to rely on artemisinin and its partner drugs to eliminate malaria in the Greater Mekong subregion." We see nothing that would prevent simple adjustments to existing regimes. , including smart use our most effective weapon against malaria and we believe that it is urgent to implement these measures before new complications are manifested. "