Kenya ripe for three-drug combo to fight malaria -- Kemri

Malaria is spread through the bite of a female Anopheles mosquito infected with the plasmodium parasite.

Experts have advised Kenya to consider an improved drug combination to treat malaria, following evidence that the disease-causing parasite is developing resistance to the drugs currently used in Kenya.

 They proposed a combination of three drugs because if the current two-drug therapy fails and there is no alternative, Kenya’s malaria strategy could collapse.

 “Triple-ACTs combining lumefantrine with piperaquine or amodiaquine could help maintain drug efficacy,” they said.

 Experts from the Kenya Medical Research Institute and Brown University, US, made the recommendation after tracking the parasite’s resistance to malaria drugs in Kenya between 1998 and 2021, in the most comprehensive such study in East Africa to date.

 Kenya’s official first-line treatment for uncomplicated malaria is Artemether-Lumefantrine (AL), a combination of two drugs: Artemether (a fast-acting drug derived from the sweet wormwood plant) and Lumefantrine, a longer-acting drug that clears remaining parasites.

 Kenya adopted AL in 2006, following World Health Organization recommendations to switch from older drugs that the parasite had become resistant to (like chloroquine and SP).

 “Kenya may be ripe for artemisinin resistance spread with ancillary mutations and the undermining of partner drugs,” the research done by Kemri and its partner indicates.

 The findings have been published on the preprint server MedRxiv, in a paper titled, “Two decades of molecular surveillance in Kenya reveal shifting Plasmodium falciparum drug resistance mutations linked to frontline drug changes.”

 Malaria is spread through the bite of a female Anopheles mosquito infected with the plasmodium parasite.

 The researchers analysed 642 blood samples from malaria patients across Kenya, collected between 1998 and 2021. They analysed parasites found in the blood using powerful genetic tools, helping them track how the malaria parasite has changed in response to Kenya’s shifting drug policies.

 They found that after artemether-lumefantrine was adopted in Kenya in 2006, mutations that help the parasite survive the drug began rising sharply.

 “Following the adoption of artemether-lumefantrine in 2006, we observed a rapid expansion of MDR1 N86N, Y184F, and D1246D alleles associated with reduced lumefantrine susceptibility,” the researchers observed.

 Kenya’s national malaria treatment strategy has changed multiple times in the past 25 years, but the new findings suggest the parasite has kept up and sometimes even anticipated new treatments before they came.

  “These findings demonstrate the rapid and dynamic evolution of drug resistance in response to shifting antimalarial drug pressures,” the scientists said. “They underscore the need for sustained genomic surveillance in malaria-endemic regions to inform adaptive treatment strategies.”

 Currently, no country deploys the proposed three-drug combination – known as Triple Artemisinin-Based Combination Therapies (TACTs) -as standard first-line malaria treatment. Instead, pilot and fallback strategies are underway primarily in Southeast Asia.

 Cambodia is already considering including TACTs in its national elimination policy and preparing for fast deployment if resistance worsens.

 But most countries in Africa say it all depends on WHO endorsement and international funding.

 The WHO still recommends the two-drug Artemisinin-based combination therapy as the first-line treatment for uncomplicated malaria. It says TACT may be considered in areas with high levels of drug resistance to ACT or in specific clinical situations where other treatment options are limited.