Cheap and effective: new hope for treating drug-resistant malaria in Vietnam

Southeast Asia has the most highly drug-resistant malaria in the world, which severely limits treatment options. Researchers from Vietnam’s Hospital for Tropical Diseases tested a new combination tablet: dihydroartemisinin-piperaquine. Their results show that this inexpensive, safe and effective treatment could be a useful weapon in the fight against malaria.

Researchers agree that the best way to combat anti-malarial resistanceis to use a combination of drugs including an artemisininderivative, if possible in a single tablet. The only combination currentlyavailable in this format is artemether-lumefantrine,which is relatively expensive in Vietnam (US$ 2.40 per treatment). Thisresearch, which aimed to find a cheaper alternative, had two phases. In a pilotstudy at the Hospital for Tropical Diseases in Ho Chi MinhCity, 76 patients received treatment for three days with dihydroartemisinin-trimethoprim-piperaquine(DTP), while 38 had the standard artesunate-mefloquine(AM) treatment. A second trial, at the Dac O HealthStation in Binh PhuocProvince, compared DTP, dihydroartemisinin-piperaquine(DP) and AM in 400 patients.

Their findings included:

• The 56 day cure rates in the pilot study were97.4 percent for DTP and 100 percent for AM.
• In the second study, they were 97.4 percent forDTP, 98.7 percent for DP and 98.7 percent for AM.
• Fewer than 3 percent of patients had sideeffects that might have been related to treatment with DTP or DP, compared with16 percent for AM.

This research shows that DP is an inexpensive, safe, highlyeffective fixed-dose antimalarial combinationtreatment, which could give a boost to the control of multidrug-resistantmalaria. DP has several advantages over AM:

• It is a fixed-dose tablet, which improvesadherence.
• It has fewer side effects.
• It is much cheaper.

Cost is a major factor deterring countries and internationaldonors from providing artemisinin-based combinationsto combat the worsening global malaria situation. Widely-used but ever moreineffective drugs, such as chloroquine and sulphadoxine-pyrimethamine, cost less than 20 cents pertreatment. DP costs about US$ 1, which is generally seen as the upper limit ofaffordability for an anti-malarial treatment in most affected countries. However,the cost of AM, Vietnam’s standard malaria treatment, is US$ 6. This provides astrong incentive for the quite small investments that are needed to make DP andother artemisinin-based combinations widelyavailable.