ArticleAntimicrobial agents and chemotherapy2015
How Robust Are Malaria Parasite Clearance Rates as Indicators of Drug Effectiveness and Resistance?
Article in Antimicrobial agents and chemotherapy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 69 citations in OpenAlex.
- Safety and parasite clearance of artemisinin-resistant Plasmodium falciparum infection: A pilot and a randomised volunteer infection study in Australia.PLoS medicine · 2020Trial
- Assessment of parasite clearance following treatment of severe malaria with intravenous artesunate in Ugandan children enrolled in a randomized controlled clinical trial.Malaria journal · 2018Trial
- A Phase II pilot trial to evaluate safety and efficacy of ferroquine against early Plasmodium falciparum in an induced blood-stage malaria infection study.Malaria journal · 2016Trial
- Linking Murine and Human Plasmodium falciparum Challenge Models in a Translational Path for Antimalarial Drug Development.Antimicrobial agents and chemotherapy · 2016Trial
- Fractional curative killing of pyronaridine or artesunate combinations with tafenoquine, 4-aminoquinolines, or azithromycin in a murine malaria-luciferase model.Antimicrobial agents and chemotherapy · 2025Article
- Clinically applicable parasite viability assay for rapid assessment of antimalarial pharmacodynamic endpoints.Antimicrobial agents and chemotherapy · 2025Article
- IncompleteFrontiers in cellular and infection microbiology · 2024Article
- An artesunate pharmacometric model to explain therapeutic responses in falciparum malaria.The Journal of antimicrobial chemotherapy · 2023Article
- Parasite Viability as a Measure ofAntimicrobial agents and chemotherapy · 2022Article
- Low Complexity of Infection Is Associated With Molecular Persistence ofFrontiers in epidemiology · 2022Article
- Efficient Treatment of Experimental Cerebral Malaria by an Artemisone-SMEDDS System: Impact of Application Route and Dosing Frequency.Antimicrobial agents and chemotherapy · 2021Article
- Methnaridine is an orally bioavailable, fast-killing and long-acting antimalarial agent that cures Plasmodium infections in mice.British journal of pharmacology · 2020Article
- Evaluation of residual submicroscopic Plasmodium falciparum parasites 3 days after initiation of treatment with artemisinin-based combination therapy.Malaria journal · 2020Review
- Article
- Rapid phenotyping towards personalized malaria medicine.Malaria journal · 2020Article
- Effects of lemon decoction on malaria parasite clearance and selected hematological parameters in Plasmodium berghei ANKA infected mice.BMC complementary medicine and therapies · 2020Article
- K13-propeller gene polymorphisms of Plasmodium falciparum and the therapeutic effect of artesunate among migrant workers returning to Guangxi, China (2014-2017).Malaria journal · 2019Article
- Triple artemisinin-containing combination anti-malarial treatments should be implemented now to delay the emergence of resistance: the case against.Malaria journal · 2019Article
- Review
- Artemisinin Resistance and Stage Dependency of Parasite Clearance in Falciparum Malaria.The Journal of infectious diseases · 2019Article
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
Artemisinin-based combination therapies (ACTs) are currently the first-line drugs for treating uncomplicated falciparum malaria, the most deadly of the human malarias. Malaria parasite clearance rates estimated from patients' blood following ACT treatment have been widely adopted as a measure of drug effectiveness and as surveillance tools for detecting the presence of potential artemisinin resistance. This metric has not been investigated in detail, nor have its properties or potential shortcomings been identified. Herein, the pharmacology of drug treatment, parasite biology, and human immunity are combined to investigate the dynamics of parasite clearance following ACT. This approach parsimoniously recovers the principal clinical features and dynamics of clearance. Human immunity is the primary determinant of clearance rates, unless or until artemisinin killing has fallen to near-ineffective levels. Clearance rates are therefore highly insensitive metrics for surveillance that may lead to overconfidence, as even quite substantial reductions in drug sensitivity may not be detected as lower clearance rates. Equally serious is the use of clearance rates to quantify the impact of ACT regimen changes, as this strategy will plausibly miss even very substantial increases in drug effectiveness. In particular, the malaria community may be missing the opportunity to dramatically increase ACT effectiveness through regimen changes, particularly through a switch to twice-daily regimens and/or increases in artemisinin dosing levels. The malaria community therefore appears overreliant on a single metric of drug effectiveness, the parasite clearance rate, that has significant and serious shortcomings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.