The pipeline of medicines to support malaria control and elimination
Tim Wells, Chief Scientific Officer at Medicines for Malaria Venture (MMV)
Medicines have played a key role in the elimination of malaria from almost 100 countries worldwide, both as chemoprevention agents and also as treatments. The key challenges moving forward can be divided up into two areas: maximizing the potential of the existing therapeutics, and designing the next generation. MMV and its partners have brought high quality data allowing stringent regulatory agency approval for fixed dose combination child friendly medicines for malaria treatment. Over 200 million such treatments have been produced to date. In addition, we are working to ensure the availability of artesunate for severe malaria. The recent studies in seasonal malaria underline the efficacy and cost-effectiveness of these approaches in chemoprotection.
Looking forwards, then the drive is towards a medicine which is a single exposure radical cure and chemprevention. New agents are currently in phase II trials (OZ439 and KAE609) which could potentially be part of a single dose schizonticide, and many of these show interesting activity in transmission blocking assays. In addition, their substantial plasma half-lives point to a role in chemoprotection. Recent data from a phase II study with tafenoquine has underlined its potential as a single dose antirelapse agent. More new molecules are coming into the clinical pipeline from phenotypic screening, and we are now able to rapidly profile them in in vivo assays. In the future, decision making will be accelerated still further by the early use of human experimental challenge models, both for blood and liver stages. Ultimately, these models need the correct genotypic background, and therefore it is important that continued experimental medicine investments include disease endemic country sites.
The pipeline of new medicines looks much stronger today than it did five years ago. Sustained support is needed over the next decade to ensure that the correct medicines are moved forwards and the correct combinations are developed for the benefit of our patients.