Perspective - (2025) Volume 14, Issue 1
Received: 02-Jan-2025, Manuscript No. mcce-25-172332;
Editor assigned: 06-Jan-2025, Pre QC No. P-172332;
Reviewed: 20-Jan-2025, QC No. Q-172332;
Revised: 23-Jan-2025, Manuscript No. R-172332;
Published:
30-Jan-2025
, DOI: 10.37421/2470-6965.2025.14.386
Citation: Okoroe, Samuel. ”Artemisinin Therapies: Efficacy, Resistance, New Strategies.” Malar Contr Elimination 14 (2025):386.
Copyright: © 2025 Okoroe S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution and reproduction in any medium, provided the original author and source are credited.
Artemisinin-Based Combination Therapies (ACTs) stand as the bedrock for treating uncomplicated Plasmodium falciparum malaria, a disease that continues to present a formidable global health challenge. A comprehensive systematic review and network meta-analysis evaluating the efficacy and safety of various ACTs confirmed their uniformly high efficacy. This research also pointed out that certain combinations, specifically dihydroartemisinin-piperaquine and artemether-lumefantrine, might offer slight advantages in particular outcomes or exhibit differing safety profiles, furnishing vital insights for treatment guidelines and policy formulation [1].
In Africa, the implementation of ACTs has profoundly reshaped the landscape of malaria control. A systematic review and meta-analysis on their impact revealed a significant reduction in malaria morbidity and mortality across the continent, underscoring their indispensable role in public health programs, even as concerns about emerging resistance in some areas persist [2].
Beyond their direct therapeutic effects on clinical disease, ACTs significantly contribute to malaria control by influencing transmission dynamics. Studies indicate that ACTs, especially those with longer half-life partner drugs, can effectively reduce gametocyte carriage, thereby disrupting the human-to-mosquito transmission cycle and bolstering malaria elimination efforts [8].
The economic implications of these therapies are also significant; a systematic review on cost-effectiveness found that while ACTs are generally cost-effective interventions for uncomplicated malaria, their economic value can vary based on the specific combination used, the local epidemiological context, and the structure of the healthcare system, providing essential information for resource allocation and health planning [9].
However, the continued effectiveness of ACTs is not without its complexities and threats. For instance, the pharmacokinetics and pharmacodynamics of ACTs can be significantly altered in special populations such as pregnant women, young children, and individuals infected with HIV. Physiological changes or potential drug-drug interactions in these vulnerable groups can modify drug exposure, which in turn might affect both the efficacy and safety of the treatment, highlighting a pressing need for tailored dosing regimens to optimize patient outcomes [4].
Furthermore, the safety and tolerability of ACTs, while generally high, necessitate careful consideration, particularly regarding potential cardiotoxicity. A focused review on this aspect has compiled available evidence on cardiac adverse events associated with different ACT components. The conclusion drawn is that continuous monitoring for rare cardiovascular effects is warranted, especially in patients who are particularly vulnerable or have pre-existing conditions [7].
A paramount and escalating threat to ACT efficacy is the emergence and spread of artemisinin resistance. A dedicated scoping review on this issue in Africa synthesized current evidence, pinpointing geographical hotspots and the molecular markers correlated with resistance. This review emphasized the critical need for heightened surveillance and innovative strategies to safeguard the effectiveness of ACTs against this spreading challenge [3].
Globally, molecular markers, notably K13 propeller mutations, are identified as key indicators of artemisinin resistance in Plasmodium falciparum malaria. Their clinical implications for treatment efficacy are substantial, stressing the importance of genotyping in surveillance efforts to track and contain the dissemination of drug-resistant parasites [5].
The pervasive challenge of drug-resistant malaria, especially as it targets ACTs, represents a severe global threat. This issue encompasses the complex mechanisms of resistance, including K13 mutations, and the geographical expansion of resistant strains. Expert analysis underscores the urgent need for unwavering surveillance, the development of new anti-malarial drugs, and robust public health interventions to combat this escalating problem and preserve the integrity of existing therapies [6].
Against this backdrop, ongoing research is focused on recent advances and future directions for ACTs. This includes exploring novel drug formulations, developing strategies to circumvent resistance, and engineering next-generation combinations, reflecting continuous global efforts to maintain the efficacy of these essential drugs and ensure sustainable malaria control in the face of evolving parasite challenges [10].
Artemisinin-Based Combination Therapies (ACTs) are critical in the global fight against malaria, particularly for uncomplicated Plasmodium falciparum infections. A systematic review and network meta-analysis confirmed the high efficacy of various ACTs, highlighting that specific combinations, such as dihydroartemisinin-piperaquine and artemether-lumefantrine, might offer slight advantages in certain outcomes or possess varying safety profiles, providing crucial insights for treatment guidelines [1]. The impact of ACT implementation across Africa has been significant, leading to a demonstrable reduction in malaria morbidity and mortality and reinforcing their vital role in continental malaria control programs [2]. Beyond treating active infections, ACTs contribute to malaria elimination efforts by reducing gametocyte carriage, thereby disrupting the parasite's life cycle and lessening human-to-mosquito transmission, especially with partner drugs having longer half-lives [8]. Economically, ACTs are largely considered cost-effective interventions for uncomplicated malaria, though their specific economic value can differ depending on the combination, local epidemiology, and healthcare system [9].
Despite their broad effectiveness, the use of ACTs demands careful consideration for specific patient demographics. Pharmacokinetics and pharmacodynamics are altered in special populations like pregnant women, young children, and HIV-infected individuals. Physiological changes or drug-drug interactions in these groups can modify drug exposure, potentially affecting efficacy and safety, thus necessitating tailored dosing regimens to optimize treatment outcomes [4]. The safety and tolerability of ACTs are generally favorable, but continuous monitoring for rare cardiovascular effects, known as cardiotoxicity, is warranted, particularly in vulnerable patient groups or those with pre-existing conditions [7].
A pressing and escalating threat to the sustained efficacy of ACTs is the emergence and proliferation of artemisinin resistance. A scoping review focusing on Africa synthesized current evidence, identifying geographical hotspots and molecular markers linked to resistance, and underscored the urgent need for enhanced surveillance and innovative strategies to preserve ACT efficacy [3]. Globally, molecular markers, specifically K13 propeller mutations, have been identified as key indicators of artemisinin resistance in Plasmodium falciparum malaria. Understanding their clinical implications for treatment efficacy is paramount, emphasizing the importance of genotyping in surveillance efforts to track and contain the spread of drug-resistant parasites [5].
This growing challenge of drug-resistant malaria poses a significant global threat to the continued effectiveness of ACTs. Reviews cover the intricate mechanisms of resistance, including K13 mutations, and meticulously map the geographical spread of resistant strains. Experts emphasize the imperative need for continuous surveillance, the development of new anti-malarial drugs, and effective public health interventions to combat this escalating challenge and protect the efficacy of existing therapies [6].
To counteract these evolving challenges, the field of malaria treatment is constantly advancing. Recent progress and future directions in ACTs include the exploration of novel drug formulations, the development of sophisticated strategies to overcome resistance, and the creation of next-generation combination therapies. These efforts reflect an ongoing commitment to maintain the efficacy of these essential drugs and ensure sustainable malaria control in the face of persistent parasite challenges [10].
Artemisinin-Based Combination Therapies (ACTs) are crucial for treating uncomplicated Plasmodium falciparum malaria, consistently demonstrating high efficacy, though specific combinations may offer minor advantages or have different safety profiles, providing insights for treatment guidelines. These therapies have profoundly reduced malaria morbidity and mortality across Africa, reinforcing their critical role in malaria control programs. ACTs are generally considered cost-effective interventions, with their economic value varying by context, and they also significantly impact transmission by reducing gametocyte carriage, thus contributing to elimination efforts. However, the sustained effectiveness of ACTs is threatened by the emergence and spread of artemisinin resistance, particularly in Africa, identified through geographical hotspots and molecular markers like K13 propeller mutations. This resistance is a global concern, necessitating enhanced surveillance and new drug development. Considerations for ACT use include altered pharmacokinetics and pharmacodynamics in special populations, such as pregnant women and young children, requiring tailored dosing. Continuous monitoring for potential cardiotoxicity is also warranted, especially in vulnerable groups. Research is actively focused on advances in ACTs, including new formulations, strategies to overcome resistance, and the development of next-generation combinations, highlighting an ongoing commitment to preserve their efficacy against evolving parasite challenges and ensure sustainable malaria control globally.
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