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• W2035992308 abstract "Your Special Report (July 25, p 277)1Samarasekera U Countries race to contain resistance to key antimalarial.Lancet. 2009; 374: 277-280Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar provides a timely and balanced account of ongoing efforts to contain the spread of artemisinin-resistant falciparum malaria on the Thai–Cambodian border.One of the most urgent and challenging priorities is to replace the use of artemisinin monotherapy in Cambodia2Yeung S Van Damme W Socheat D White NJ Mills A Access to artemisinin combination therapy for malaria in remote areas of Cambodia.Malar J. 2008; 7: 96Crossref PubMed Scopus (97) Google Scholar with a fixed-dose combination such as artesunate–mefloquine or dihydroartemisinin–piperaquine. Dihydroartemisinin–piperaquine is safe and effective in Cambodia3Denis MB Davis TM Hewitt S et al.Efficacy and safety of dihydroartemisinin-piperaquine (Artekin) in Cambodian children and adults with uncomplicated falciparum malaria.Clin Infect Dis. 2002; 35: 1469-1476Crossref PubMed Scopus (123) Google Scholar, 4Janssens B van Herp M Goubert L et al.A randomized open study to assess the efficacy and tolerability of dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria in Cambodia.Trop Med Int Health. 2007; 12: 251-259Crossref PubMed Scopus (50) Google Scholar and elsewhere.5Tran TH Dolecek C Pham PM et al.Dihydroartemisinin-piperaquine against multidrug-resistant Plasmodium falciparum malaria in Vietnam: randomised clinical trial.Lancet. 2004; 363: 18-22Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar However, there is still no quality-approved product on WHO's list of prequalified drugs, making it almost impossible to procure with donor funds.The continued availability of artemisinins as separate tablets threatens the entire class of combination drugs. Why does this happen? Partly because of skewed incentives in the pharmaceutical industry, and partly through bureaucracy. Many manufacturers of new combination therapies are small-scale industries and lack the resources to clear the final hurdles of stringent international drug regulatory requirements. And why should they, when they can market their products in the thriving and often poorly regulated private sector in malaria-endemic countries? They will need extra incentives if they are to meet the necessarily exacting quality, safety, and efficacy standards required for WHO approval.We need to be able to fast-track drugs that are of major global health significance by creating incentives to invest in fast approval and large-scale generic production. Lessons can be learned from the vaccine field, where the pilot advanced market commitment has encouraged drug companies to invest in pneumococcal vaccines suitable for developing countries.Where public health emergencies such as artemisinin resistance loom, we cannot allow our most useful tools to get stuck in the pipeline.We declare that we have no conflicts of interest. Your Special Report (July 25, p 277)1Samarasekera U Countries race to contain resistance to key antimalarial.Lancet. 2009; 374: 277-280Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar provides a timely and balanced account of ongoing efforts to contain the spread of artemisinin-resistant falciparum malaria on the Thai–Cambodian border. One of the most urgent and challenging priorities is to replace the use of artemisinin monotherapy in Cambodia2Yeung S Van Damme W Socheat D White NJ Mills A Access to artemisinin combination therapy for malaria in remote areas of Cambodia.Malar J. 2008; 7: 96Crossref PubMed Scopus (97) Google Scholar with a fixed-dose combination such as artesunate–mefloquine or dihydroartemisinin–piperaquine. Dihydroartemisinin–piperaquine is safe and effective in Cambodia3Denis MB Davis TM Hewitt S et al.Efficacy and safety of dihydroartemisinin-piperaquine (Artekin) in Cambodian children and adults with uncomplicated falciparum malaria.Clin Infect Dis. 2002; 35: 1469-1476Crossref PubMed Scopus (123) Google Scholar, 4Janssens B van Herp M Goubert L et al.A randomized open study to assess the efficacy and tolerability of dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria in Cambodia.Trop Med Int Health. 2007; 12: 251-259Crossref PubMed Scopus (50) Google Scholar and elsewhere.5Tran TH Dolecek C Pham PM et al.Dihydroartemisinin-piperaquine against multidrug-resistant Plasmodium falciparum malaria in Vietnam: randomised clinical trial.Lancet. 2004; 363: 18-22Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar However, there is still no quality-approved product on WHO's list of prequalified drugs, making it almost impossible to procure with donor funds. The continued availability of artemisinins as separate tablets threatens the entire class of combination drugs. Why does this happen? Partly because of skewed incentives in the pharmaceutical industry, and partly through bureaucracy. Many manufacturers of new combination therapies are small-scale industries and lack the resources to clear the final hurdles of stringent international drug regulatory requirements. And why should they, when they can market their products in the thriving and often poorly regulated private sector in malaria-endemic countries? They will need extra incentives if they are to meet the necessarily exacting quality, safety, and efficacy standards required for WHO approval. We need to be able to fast-track drugs that are of major global health significance by creating incentives to invest in fast approval and large-scale generic production. Lessons can be learned from the vaccine field, where the pilot advanced market commitment has encouraged drug companies to invest in pneumococcal vaccines suitable for developing countries. Where public health emergencies such as artemisinin resistance loom, we cannot allow our most useful tools to get stuck in the pipeline. We declare that we have no conflicts of interest. Countries race to contain resistance to key antimalarialResistance to an antimalarial has developed on the Thai/Cambodia border, with potential for global spread. But a huge effort is underway to contain the problem. Udani Samarasekera reports. Full-Text PDF" @default.
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