Abstract
In vivo drug clinical trials are the gold standard for assessing the therapeutic efficacy of antimalarials. They must be conducted in a rigorous and standardized manner so that the resistance of antimalarial drugs can be compared both in time and in space. This chapter presents the methodology for conducting such clinical studies of antimalarials for the treatment of uncomplicated malaria and describes the logistical difficulties and limitations of this methodology. Finally it highlights the importance of such knowledge in preventing resistance, in prolonging the utility of existing antimalarial drugs, and in ensuring that all individuals and populations suffering from malaria get the right malaria treatment at the right time.
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References
Miller LH, Baruch DI, Marsh K et al (2002) The pathogenic basis of malaria. Nature 415:673–679
Guerra CA, Howes RE, Patil AP et al (2010) The international limits and population at risk of Plasmodium vivax transmission in 2009. PLoS Negl Trop Dis 4:e774
Hay SI, Guerra CA, Gething PW et al (2009) A world malaria map: Plasmodium falciparum endemicity in 2007. PLoS Med 6:e1000048
World Health Organization (2017) World malaria report 2017. World Health Organization, Geneva
DALYs GBD, Collaborators H (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1260–1344
Ariey F, Witkowski B, Amaratunga C et al (2014) A molecular marker of artemisinin-resistant Plasmodium falciparum malaria. Nature 505:50–55
Witkowski B, Amaratunga C, Khim N et al (2013) Novel phenotypic assays for the detection of artemisinin-resistant Plasmodium falciparum malaria in Cambodia: in-vitro and ex-vivo drug-response studies. Lancet Infect Dis 13:1043–1049
Witkowski B, Duru V, Khim N et al (2017) A surrogate marker of piperaquine-resistant Plasmodium falciparum malaria: a phenotype-genotype association study. Lancet Infect Dis 17:174–183
Duru V, Khim N, Leang R et al (2015) Plasmodium falciparum dihydroartemisinin-piperaquine failures in Cambodia are associated with mutant K13 parasites presenting high survival rates in novel piperaquine in vitro assays: retrospective and prospective investigations. BMC Med 13:305
World Health Organization (2009) Methods for surveillance of antimalarial drug efficacy. World Health Organization, Geneva
White NJ (2011) The parasite clearance curve. Malar J 10:278
O’Flaherty K, Maguire J, Simpson JA et al (2017) Immunity as a predictor of anti-malarial treatment failure: a systematic review. Malar J 16:158
World Health Organization (2014) Severe malaria. Tropical Med Int Health 19:7–131
Dalrymple U, Arambepola R, Gething PW et al (2018) How long do rapid diagnostic tests remain positive after anti-malarial treatment? Malar J 17:228
Vafa Homann M, Emami SN, Yman V et al (2017) Detection of malaria parasites after treatment in travelers: A 12-months longitudinal study and statistical modelling analysis. EBioMedicine 25:66–72
Imwong M, Stepniewska K, Tripura R et al (2016) Numerical distributions of parasite densities during asymptomatic malaria. J Infect Dis 213:1322–1329
Imwong M, Woodrow CJ, Hendriksen IC et al (2015) Plasma concentration of parasite DNA as a measure of disease severity in falciparum malaria. J Infect Dis 211:1128–1133
World Health Organization (2015) Microscopy for the detection, identification and quantification of malaria parasites on stained thick and thin blood films in research settings (version 1.0); procedure: methods manual. World Health Organization, Geneva
Dahal P, Simpson JA, Dorsey G et al (2017) Statistical methods to derive efficacy estimates of anti-malarials for uncomplicated Plasmodium falciparum malaria: pitfalls and challenges. Malar J 16:430
World Health Organization (1996) Assessment of therapeutic efficacy of antimalarial drugs for uncomplicated falciparum malaria in areas with intense transmission. World Health Organization, Geneva
World Health Organization (2003) Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. World Health Organization, Geneva
World Health Organization (1965) Resistance of malaria parasites to drugs. Report of a WHO scientific group. World Health Organization, Geneva
World Health Organization (1967) Chemotherapy of malaria. Report of a WHO sientific group. World Health Organization, Geneva
Stepniewska K, Taylor WR, Mayxay M et al (2004) In vivo assessment of drug efficacy against Plasmodium falciparum malaria: duration of follow-up. Antimicrob Agents Chemother 48:4271–4280
Stepniewska K, White NJ (2006) Some considerations in the design and interpretation of antimalarial drug trials in uncomplicated falciparum malaria. Malar J 5:127
White NJ (2002) The assessment of antimalarial drug efficacy. Trends Parasitol 18:458–464
PCSG WWARN (2015) Baseline data of parasite clearance in patients with falciparum malaria treated with an artemisinin derivative: an individual patient data meta-analysis. Malar J 14:359
Ashley EA, Pinoges L, Turyakira E et al (2008) Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children. Malar J 7:154
Verret WJ, Dorsey G, Nosten F et al (2009) The effect of varying analytical methods on estimates of anti-malarial clinical efficacy. Malar J 8:77
Guthmann JP, Pinoges L, Checchi F et al (2006) Methodological issues in the assessment of antimalarial drug treatment: analysis of 13 studies in eight African countries from 2001 to 2004. Antimicrob Agents Chemother 50:3734–3739
Nosten F, White NJ (2007) Artemisinin-based combination treatment of falciparum malaria. Am J Trop Med Hyg 77:181–192
Ashley EA, Dhorda M, Fairhurst RM et al (2014) Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 371:411–423
Dondorp AM, Nosten F, Yi P et al (2009) Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 361:455–467
Flegg JA, Guerin PJ, Nosten F et al (2013) Optimal sampling designs for estimation of Plasmodium falciparum clearance rates in patients treated with artemisinin derivatives. Malar J 12:411
Flegg JA, Guerin PJ, White NJ et al (2011) Standardizing the measurement of parasite clearance in falciparum malaria: the parasite clearance estimator. Malar J 10:339
WWARN AbCTABSG (2015) Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data. BMC Med 13:212
World Health Organization (2008) Methods and techniques for clinical trials on antimalarial drug efficacy–genotyping to identify parasite populations: informal consultation organized by the Medicines for Malaria Venture and cosponsored by the World Health Organization, 29–31 May 2007, Amsterdam, The Netherlands. World Health Organization, Geneva
Juliano JJ, Taylor SM, Meshnick SR (2009) Polymerase chain reaction adjustment in antimalarial trials: molecular malarkey? J Infect Dis 200:5–7
Messerli C, Hofmann NE, Beck HP et al (2017) Critical evaluation of molecular monitoring in malaria drug efficacy trials and pitfalls of length-polymorphic markers. Antimicrob Agents Chemother 61. https://doi.org/10.1128/AAC.01500-16
Snounou G, Beck HP (1998) The use of PCR genotyping in the assessment of recrudescence or reinfection after antimalarial drug treatment. Parasitol Today 14:462–467
Juliano JJ, Gadalla N, Sutherland CJ et al (2010) The perils of PCR: can we accurately ‘correct’ antimalarial trials? Trends Parasitol 26:119–124
White MT, Karl S, Koepfli C et al (2018) Plasmodium vivax and Plasmodium falciparum infection dynamics: re-infections, recrudescences and relapses. Malar J 17:170
Greenhouse B, Myrick A, Dokomajilar C et al (2006) Validation of microsatellite markers for use in genotyping polyclonal Plasmodium falciparum infections. Am J Trop Med Hyg 75:836–842
Thanapongpichat S, McGready R, Luxemburger C et al (2013) Microsatellite genotyping of Plasmodium vivax infections and their relapses in pregnant and non-pregnant patients on the Thai-Myanmar border. Malar J 12:275
Daniels R, Volkman SK, Milner DA et al (2008) A general SNP-based molecular barcode for Plasmodium falciparum identification and tracking. Malar J 7:223
Lerch A, Koepfli C, Hofmann NE et al (2017) Development of amplicon deep sequencing markers and data analysis pipeline for genotyping multi-clonal malaria infections. BMC Genomics 18:864
White NJ, Stepniewska K, Barnes K et al (2008) Simplified antimalarial therapeutic monitoring: using the day-7 drug level? Trends Parasitol 24:159–163
World Health Organization (2011) Methods and techniques for assessing exposure to antimalarial drugs in clinical field studies. World Health Organization, Geneva
Phyo AP, Ashley EA, Anderson TJC et al (2016) Declining efficacy of Artemisinin combination therapy against P. falciparum malaria on the Thai-Myanmar border (2003-2013): The role of parasite genetic factors. Clin Infect Dis 63:784–791
Tools for monitoring antimalarial drug efficacy [http://www.who.int/malaria/areas/drug_resistance/efficacy-monitoring-tools/en/]
Malaria Clinical Trials Toolkit [http://www.wwarn.org/tools-resources/malaria-clinical-trials-toolkit]
Adjuik MA, Allan R, WorldWide Antimalarial Resistance Network ASAQSG et al (2015) The effect of dosing strategies on the therapeutic efficacy of artesunate-amodiaquine for uncomplicated malaria: a meta-analysis of individual patient data. BMC Med 13:66
WorldWide Antimalarial Resistance Network (2013) The effect of dosing regimens on the antimalarial efficacy of dihydroartemisinin-piperaquine: a pooled analysis of individual patient data. PLoS Med 10:e1001564
Acknowledgments
We thank Dr. Mavuto Mukaka for the advice and assistance in providing the sample size calculations.
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Dhorda, M.J., Dondorp, A.M. (2019). In Vivo Assessments to Detect Antimalarial Resistance. In: Ariey, F., Gay, F., Ménard, R. (eds) Malaria Control and Elimination. Methods in Molecular Biology, vol 2013. Humana, New York, NY. https://doi.org/10.1007/978-1-4939-9550-9_8
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DOI: https://doi.org/10.1007/978-1-4939-9550-9_8
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