ArticleThe Lancet. Global health2015
Optimum population-level use of artemisinin combination therapies: a modelling study.
Article in The Lancet. Global health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
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Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it, 81 citations in OpenAlex.
- Agent-based models of malaria transmission: a systematic review.Malaria journal · 2018Pooled it
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- Review
- Global risk of selection and spread of Plasmodium falciparum histidine-rich protein 2 and 3 gene deletions.Nature medicine · 2025Article
- Multiple first-line therapeutic strategies to mitigate artemisinin resistance: cost analysis of a pilot study from a health system perspective in Kaya health district, Burkina Faso.Malaria journal · 2025Article
- Effects of recombination on multi-drug resistance evolution in Plasmodium falciparum malaria.PLoS computational biology · 2025Article
- The transmission blocking activity of artemisinin-combination, non-artemisinin, and 8-aminoquinoline antimalarial therapies: A pooled analysis of individual participant data.PLoS medicine · 2025Article
- Risk of selection and timelines for the continued spread of artemisinin and partner drug resistance in Africa.medRxiv : the preprint server for health sciences · 2024Article
- Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries.Tropical medicine and infectious disease · 2024Article
- Role of seasonal importation and genetic drift on selection for drug-resistant genotypes ofJournal of the Royal Society, Interface · 2024Article
- Assessing emergence risk of double-resistant and triple-resistant genotypes of Plasmodium falciparum.Nature communications · 2024Article
- The impact of home-based management of malaria on clinical outcomes in sub-Saharan African populations: a systematic review and meta-analysis.Tropical medicine and health · 2024Article
- Recent updates in the WHO guidelines for malaria case management.Sudanese journal of paediatrics · 2024Review
- Modeling policy interventions for slowing the spread of artemisinin-resistant pfkelch R561H mutations in Rwanda.Nature medicine · 2023Article
- Modeling to guide drug policy response to artemisinin-resistant malaria in Rwanda.Nature medicine · 2023Article
- Role of Seasonal Importation and Random Genetic Drift on Selection for Drug-Resistant Genotypes ofbioRxiv : the preprint server for biology · 2023Article
- Preventing antimalarial drug resistance with triple artemisinin-based combination therapies.Nature communications · 2023Article
- Dual-pharmacophore artezomibs hijack the Plasmodium ubiquitin-proteasome system to kill malaria parasites while overcoming drug resistance.Cell chemical biology · 2023Article
- Feasibility and Acceptability of a Strategy Deploying Multiple First-Line Artemisinin-Based Combination Therapies for Uncomplicated Malaria in the Health District of Kaya, Burkina Faso.Tropical medicine and infectious disease · 2023Article
- National-scale simulation of human movement in a spatially coupled individual-based model of malaria in Burkina Faso.Scientific reports · 2023Article
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundArtemisinin combination therapies (ACTs) are used worldwide as first-line treatment against confirmed or suspected Plasmodium falciparum malaria. Despite the success of ACTs at reducing the global burden of malaria, emerging resistance to artemisinin threatens these gains. Countering onset of resistance might need deliberate tactics aimed at slowing the reduction in ACT effectiveness. We assessed optimum use of ACTs at the population level, specifically focusing on a strategy of multiple first-line therapies (MFT), and comparing it with strategies of cycling or sequential use of single first-line ACTs.
methodsWith an individual-based microsimulation of regional malaria transmission, we looked at how to apply a therapy as widely as possible without accelerating reduction of efficacy by drug resistance. We compared simultaneous distribution of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine (ie, MFT) against strategies in which these ACTs would be cycled or used sequentially, either on a fixed schedule or when population-level efficacy reaches the WHO threshold of 10% treatment failure. The main assessment criterion was total number of treatment failures per 100 people per year. Additionally, we analysed the benefits of including a single non-ACT therapy in an MFT strategy, and did sensitivity analyses in which we varied transmission setting, treatment coverage, partner-drug half-life, fitness cost of drug resistance, and the relation between drug concentration and resistance evolution.
findingsUse of MFT was predicted to reduce the long-term number of treatment failures compared with strategies in which a single first-line ACT is recommended. This result was robust to various epidemiological, pharmacological, and evolutionary features of malaria transmission. Inclusion of a single non-ACT therapy in an MFT strategy would have substantial benefits in reduction of pressure on artemisinin resistance evolution, delaying its emergence and slowing its spread.
interpretationAdjusting national antimalarial treatment guidelines to encourage simultaneous use of MFT is likely to extend the useful therapeutic life of available antimalarial drugs, resulting in long-term beneficial outcomes for patients.
fundingWellcome Trust, UK Medical Research Council, Li Ka Shing Foundation.
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