A spatially coupled, individual-based simulation of malaria in Rwanda was used to evaluate changes in drug policy in response to artemisinin-resistant Plasmodium falciparum. Our findings suggest that the deployment of multiple first-line therapies has the potential to reduce treatment failures and slow the fixation of resistant alleles in populations.
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References
Uwimana, A. et al. Emergence and clonal expansion of in vitro artemisinin-resistant Plasmodium falciparum kelch13 R561H mutant parasites in Rwanda. Nat. Med. 26, 1602–1608 (2020). A report of a pfkelch13 mutant with a confirmed in vitro signal of resistance via a ring-stage survival assay.
Straimer, J. et al. High prevalence of Plasmodium falciparum K13 mutations in Rwanda is associated with slow parasite clearance after treatment with artemether–lumefantrine. J. Infect. Dis. 225, 1411–1414 (2022). This paper reports that 6 of 18 patients in Rwanda treated with artemether–lumefantrine had long parasite-clearance half-lives (>5 h).
Kirby, R. et al. Examining the early distribution of the artemisinin-resistant Plasmodium falciparum kelch13 R561H mutation in areas of higher transmission in Rwanda. Open Forum Infect. Dis., ofad149 (2023) Retrospective identification of the R561H mutation in samples collected in Rwanda between 2014 and 2015.
Nguyen, T. D. et al. Optimum population-level use of artemisinin combination therapies: a modelling study. Lancet Glob. Health 3, e758–e766 (2015). A mathematical modeling study demonstrating that the use of three ACTs simultaneously as MFTs results in slower resistance evolution.
van der Pluijm, R. W. et al. Triple artemisinin-based combination therapies versus artemisinin-based combination therapies for uncomplicated Plasmodium falciparum malaria: a multicentre, open-label, randomised clinical trial. Lancet 395, 1345–1360 (2020). This phase II/III clinical trial showed ≥96% efficacy for two different triple ACTs.
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This is a summary of: Zupko, R. J. et al. Modeling policy interventions for slowing the spread of artemisinin-resistant pfkelch R561H mutations in Rwanda. Nat. Med. https://doi.org/10.1038/s41591-023-02551-w (2023).
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Modeling to guide drug policy response to artemisinin-resistant malaria in Rwanda. Nat Med 29, 2716–2717 (2023). https://doi.org/10.1038/s41591-023-02619-7
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DOI: https://doi.org/10.1038/s41591-023-02619-7
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