New malaria treatment paves way for eradication

Aedes aegypti mosquitoes sit in a petri dish at the Fiocruz Institute in Brazil
Aedes aegypti mosquitoes sit in a petri dish at the Fiocruz Institute in Brazil Credit: Felipe Dana/AP

The US authorities have approved the first new treatment in 60 years for malaria that is endemic in Asia and Latin America.

Experts hope it will play a significant role in eliminating the mosquito-borne disease, which is on the march again after decades of decline.

The US Food and Drug Administration has approved the drug tafenoquine for the treatment of Plasmodium vivax malaria – a disease causing around 8.5million infections every year in Asia, Latin America and parts of Africa.

P. vivax malaria is seen as a milder form of the disease than Plasmodium falciparum malaria which is prevalent in Africa. However, it is an unpleasant illness, causing around 8.5million infections every year. Symptoms include fever, chills, vomiting headache and muscle pain. In some cases it can be fatal.

After being bitten by a mosquito carrying the P. vivax parasite an individual will suffer an acute episode of malaria. But the parasite can lie dormant in the liver where it reactivates to cause new episodes of malaria weeks, months or even years after the initial infection.

While there is already a drug that targets the parasite in its dormant stage – primaquine – this has to be taken over a 14-day period.

Tafenoquine, developed by UK pharmaceutical company GSK and non-profit Medicines for Malaria Venture, is a single-dose treatment.

Dr Pauline Williams, GSK’s head of global health research and development, said this was a “key advantage” of the drug.

“With every medicine that requires a prolonged course of treatment – wherever you live in the world – compliance is known to be poor. Once symptoms subside people tend not to complete the course. Giving a single treatment gives patients protection from relapse,” she said.

P. vivax is not as deadly as P. falciparum but is still a horrible disease, said Dr Williams.

“As medical students we were always taught that P. vivax was the more benign form of malaria. But the disease is miserable and is characterised by multiple relapses – each of these relapses can lead to severe complications including organ failure and death,” she said.

Scientists hope that the new drug will be an important tool in the battle to eliminate malaria, alongside existing methods such as indoor residual spraying and long-lasting insecticide treated nets.

In a study of 522 patients with P. vivax malaria 60 per cent were relapse free, six months after taking the drug.

Dr David Reddy, chief executive of MMV, said: “The US FDA’s approval of [tafenoquine] is a major milestone and a significant contribution towards global efforts to eradicate malaria. The world has waited decades for a new medicine to counter P. vivax malaria relapse. Today, we can say the wait is over.”

The drug has also been submitted for approval to the Australian regulatory authority  the Therapeutic Goods Administration (TGA). Approval from the FDA and TGA will act as a launch pad for regulatory authorities in malaria endemic countries, GSK says.

Dr Williams said: “The intent with these endemic countries is to drive access and with MMV we’re committed to providing the drug on a not-for-profit, not-for-loss basis.”

The news of the approval was welcomed by malaria campaigners.

James Whiting, executive director of Malaria No More UK, said: “Pioneering new solutions are a must to beat the world’s oldest killer disease. The approval of the single-dose cure tafenoquine is most welcome news and a momentous step forward which will save and transform countless lives."

Dr Sue Desmond-Hellmann, chief executive of the Bill & Melinda Gates Foundation, said: “This is a major milestone along the road to ending the scourge of malaria for good. Approval of the first ever radical, single-dose cure for vivax malaria means the next domino to fall on the path to eradication can be the Americas. This is an opportunity we must seize.”

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