- Email: [email protected]
Artekin: an affordable antimalarial
Newsdesk
Tuberculosis is spreading faster than efforts to control it in many highburden countries, with an estimated 9 million new cases being reported every year globally. Every day, more than 5000 people die from tuberculosis; about 100 people are newly infected each minute. 5–10% of them become active cases and, left untreated, infect another 10–15 people each year. To break this transmission chain and reach the goal of detecting 70% of cases and treating 85% of them by December 2005, high-burden countries must intensify directly observed therapy, short course (DOTS) coverage and try to reach out to segments not covered so far. Otherwise, the success achieved since 2001 could be reversed. Sounding this note of caution, the second meeting of the Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India) suggested efforts to overcome region-specific tuberculosiscontrol barriers such as HIV, drugresistant tuberculosis, poor performance of private practitioners, and prison epidemics. “A tremendous effort is needed for the coming 21 months”, observed Lee Jong-wook (Director General, WHO) addressing the Forum meeting. “This effort will need to be innovative. A good example of innovation is the new programme of Intensified Support and Action Countries, the first of which is India. These countries will be receiving technical and financial assistance to help them move up a gear”. The WHO report on global tuberculosis control, released at New Delhi, also pointed out that highburden countries in Asia must recruit patients from non-participating clinics and hospitals, while those in Africa should go beyond the present limits of public-health systems. These two regions account for most cases that are not seen and not detected by publichealth authorities under DOTS. This is necessary to increase the case detection rate from 37% to 50% and beyond. “To get above 50% case detection will be demanding because the notification rate of all TB cases by public-health authorities has been stable at about this level for many years,
256
WHO
Slow progress worries Stop TB Partnership
Stop TB global ambassador AR Rahman
and because DOTS programmes will probably have exhausted this supply of cases by 2005”, the report said. But health charity Médicins Sans Frontières (MSF) feels that DOTS programmes exclude a large number of
patients who are smear negative. Also, effectiveness of DOTS protocols has not been substantiated in large-scale clinical trials. “The treatment is far too lengthy and direct observation methods violate patient rights”, said Rowan Gillies, President, MSF international council. Gillies asked partnership members to generate resources for developing new diagnostics and drugs. Since the tuberculosis drugs market is small and may prove unattractive to large firms, smaller companies who have identified new targets should be provided with funds to develop new drugs, MSF said in a report released before the Delhi meeting. Dinesh C Sharma
Artekin: an affordable antimalarial The non-profit foundation Medicines for Malaria Venture (MMV) has signed an agreement to develop dihydroartemisinin-piperaquine (Artekin) as an affordable antimalarial for countries where the disease is endemic. “If successful, this will be one of the first antimalarial drugs in history developed primarily for a disease of the poor”, says MMV. The organisation’s partners in the venture are Chongqing Holley Holding, a Chinese pharmaceutical company, Sigma-Tau, an Italian pharmaceutical company, and the University of Oxford, UK. Artekin is a fixed-dose combination of dihydroartemisinin (an artemisinin derivative) and piperaquine—a combination that should be both highly effective and cheap, according to Nick White (Oxford University). So far there have been no known cases of resistance to artemisinin, and the dihydroartemisinin-piperaquine combination has already proved highly effective and well tolerated in large clinical trials (Lancet 2004; 363: 18–22; Clin Infect Dis 2004; 36: 1627–28). “The MMV artekin collaboration is interesting because a Chinese company is involved directly” says White. “In the past 25 years more new antimalarials have
come out of China than anywhere else in the world. This is China’s first serious attempt to produce an antimalarial that is registered internationally.” “Malaria mortality and morbidity are on the rise due to the growing problem of drug resistance”, says Christopher Hentschel of MMV. “We desperately need to replenish the diminishing pipeline of effective and affordable medicines. Not only should this antimalarial be effective, our goal is to make it available at a cost that’s affordable for people living on less than a dollar a day.” The WHO considers combinations of short-acting artemisinins with longer-acting synthetic antimalarials to be very promising, because “they may provide affordable short-course treatments that could prove durable over many years of large-scale use, even in areas of intense malaria transmission”. Malaria is making a major comeback in sub-Saharan Africa and southeast Asia, causing more than a million deaths a year. In the past 10 years in eastern and southern Africa twice as many people have died from the disease as in the previous decade. Most of the victims are young children. Dorothy Bonn
THE LANCET Infectious Diseases Vol 4 May 2004
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
Tuberculosis is spreading faster than efforts to control it in many highburden countries, with an estimated 9 million new cases being reported every year globally. Every day, more than 5000 people die from tuberculosis; about 100 people are newly infected each minute. 5–10% of them become active cases and, left untreated, infect another 10–15 people each year. To break this transmission chain and reach the goal of detecting 70% of cases and treating 85% of them by December 2005, high-burden countries must intensify directly observed therapy, short course (DOTS) coverage and try to reach out to segments not covered so far. Otherwise, the success achieved since 2001 could be reversed. Sounding this note of caution, the second meeting of the Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India) suggested efforts to overcome region-specific tuberculosiscontrol barriers such as HIV, drugresistant tuberculosis, poor performance of private practitioners, and prison epidemics. “A tremendous effort is needed for the coming 21 months”, observed Lee Jong-wook (Director General, WHO) addressing the Forum meeting. “This effort will need to be innovative. A good example of innovation is the new programme of Intensified Support and Action Countries, the first of which is India. These countries will be receiving technical and financial assistance to help them move up a gear”. The WHO report on global tuberculosis control, released at New Delhi, also pointed out that highburden countries in Asia must recruit patients from non-participating clinics and hospitals, while those in Africa should go beyond the present limits of public-health systems. These two regions account for most cases that are not seen and not detected by publichealth authorities under DOTS. This is necessary to increase the case detection rate from 37% to 50% and beyond. “To get above 50% case detection will be demanding because the notification rate of all TB cases by public-health authorities has been stable at about this level for many years,
256
WHO
Slow progress worries Stop TB Partnership
Stop TB global ambassador AR Rahman
and because DOTS programmes will probably have exhausted this supply of cases by 2005”, the report said. But health charity Médicins Sans Frontières (MSF) feels that DOTS programmes exclude a large number of
patients who are smear negative. Also, effectiveness of DOTS protocols has not been substantiated in large-scale clinical trials. “The treatment is far too lengthy and direct observation methods violate patient rights”, said Rowan Gillies, President, MSF international council. Gillies asked partnership members to generate resources for developing new diagnostics and drugs. Since the tuberculosis drugs market is small and may prove unattractive to large firms, smaller companies who have identified new targets should be provided with funds to develop new drugs, MSF said in a report released before the Delhi meeting. Dinesh C Sharma
Artekin: an affordable antimalarial The non-profit foundation Medicines for Malaria Venture (MMV) has signed an agreement to develop dihydroartemisinin-piperaquine (Artekin) as an affordable antimalarial for countries where the disease is endemic. “If successful, this will be one of the first antimalarial drugs in history developed primarily for a disease of the poor”, says MMV. The organisation’s partners in the venture are Chongqing Holley Holding, a Chinese pharmaceutical company, Sigma-Tau, an Italian pharmaceutical company, and the University of Oxford, UK. Artekin is a fixed-dose combination of dihydroartemisinin (an artemisinin derivative) and piperaquine—a combination that should be both highly effective and cheap, according to Nick White (Oxford University). So far there have been no known cases of resistance to artemisinin, and the dihydroartemisinin-piperaquine combination has already proved highly effective and well tolerated in large clinical trials (Lancet 2004; 363: 18–22; Clin Infect Dis 2004; 36: 1627–28). “The MMV artekin collaboration is interesting because a Chinese company is involved directly” says White. “In the past 25 years more new antimalarials have
come out of China than anywhere else in the world. This is China’s first serious attempt to produce an antimalarial that is registered internationally.” “Malaria mortality and morbidity are on the rise due to the growing problem of drug resistance”, says Christopher Hentschel of MMV. “We desperately need to replenish the diminishing pipeline of effective and affordable medicines. Not only should this antimalarial be effective, our goal is to make it available at a cost that’s affordable for people living on less than a dollar a day.” The WHO considers combinations of short-acting artemisinins with longer-acting synthetic antimalarials to be very promising, because “they may provide affordable short-course treatments that could prove durable over many years of large-scale use, even in areas of intense malaria transmission”. Malaria is making a major comeback in sub-Saharan Africa and southeast Asia, causing more than a million deaths a year. In the past 10 years in eastern and southern Africa twice as many people have died from the disease as in the previous decade. Most of the victims are young children. Dorothy Bonn
THE LANCET Infectious Diseases Vol 4 May 2004
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet.