Global estimation of anti-malarial drug effectiveness for the treatment of uncomplicated Plasmodium falciparum malaria 1991–2019

Malaria Journal

Samir Bhatt¹  Elisabeth G. Chestnutt²  Giulia Rathmes²  Anita K. Nandi²  Jennifer A. Rozier²  Emma L. Collins²  Tim C. D. Lucas²  Penelope Hancock²  Katherine E. Battle²  Suzanne H. Keddie²  Punam Amratia²  Michele Nguyen²  Katherine A. Twohig²  Harry S. Gibson²  Tasmin L. Symons²  Justin J. Millar²  Rohan Arambepola²  Andre Python³  Amelia Bertozzi-Villa⁴  Susan F. Rumisha⁵  Daniel J. Weiss⁶  Ewan Cameron⁶  Peter W. Gething⁷  Georgina S. Humphreys⁸  Philippe J. Guerin⁸ 

[1] Imperial College London, London, UK;Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Center for Data Science, Zhejiang University, 310058, Hangzhou, China;Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Institute for Disease Modeling, Bellevue, WA, USA;Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Telethon Kids Institute, Perth, Australia;Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Telethon Kids Institute, Perth, Australia;Curtin University, Perth, Australia;Telethon Kids Institute, Perth, Australia;Curtin University, Perth, Australia;WorldWide Anti-Malarial Resistance Network (WWARN), Oxford, UK;Infectious Diseases Data Observatory (IDDO), Oxford, UK;Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;

关键词: Falciparum malaria;    Anti-malarial drug effectiveness;    Drug quality;    Global;   

DOI  :  10.1186/s12936-020-03446-8

来源: Springer

【 摘 要 】

BackgroundAnti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time.MethodsThis study uses data from 232 efficacy trials comprised of 86,776 infected individuals to estimate the artemisinin-based and non-artemisinin-based AmE for treating falciparum malaria between 1991 and 2019. Bayesian spatiotemporal models were fitted and used to predict effectiveness at the pixel-level (5 km × 5 km). The median and interquartile ranges (IQR) of AmE are presented for all malaria-endemic countries.ResultsThe global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3–75.8), 70.1% (43.6–76.0) and 71.8% (46.9–76.4) for the 1991–2000, 2006–2010, and 2016–2019 periods, respectively. Countries in central Africa, a few in South America, and in the Asian region faced the challenge of lower effectiveness of artemisinin-based anti-malarials. However, improvements were seen after 2016, leaving only a few hotspots in Southeast Asia where resistance to artemisinin and partner drugs is currently problematic and in the central Africa where socio-demographic challenges limit effectiveness. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based with no improvement over time: 52.3% (17.9–74.9) for 1991–2000 and 55.5% (27.1–73.4) for 2011–2015. Overall, AmE for artemisinin-based and non-artemisinin-based drugs were, respectively, 29.6 and 36% below clinical efficacy as measured in anti-malarial drug trials.ConclusionsThis study provides evidence that health system performance, drug quality and patient adherence influence the effectiveness of anti-malarials used in treating uncomplicated falciparum malaria. These results provide guidance to countries’ treatment practises and are critical inputs for malaria prevalence and incidence models used to estimate national level malaria burden.

【 授权许可】

CC BY