Observational studyThe Lancet. Infectious diseases2020
Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion: an observational study.
Observational study in The Lancet. Infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 96 papers, 4 of them syntheses that pooled it.
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Who cites it
96 citing papers in PubMed, 4 syntheses or guidelines pooled it, 179 citations in OpenAlex.
- Molecular surveillance of antimalarial drug resistance genes in Nigeria: a systematic review and roadmap to malaria elimination.BMC medical genomics · 2025Pooled it
- Pooled it
- How has mass drug administration with dihydroartemisinin-piperaquine impacted molecular markers of drug resistance? A systematic review.Malaria journal · 2022Pooled it
- Mapping genetic markers of artemisinin resistance inThe Lancet. Microbe · 2022Pooled it
- Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination.Malaria journal · 2024Trial
- Trial
- Triple therapy with artemether-lumefantrine plus amodiaquine versus artemether-lumefantrine alone for artemisinin-resistant, uncomplicated falciparum malaria: an open-label, randomised, multicentre trial.The Lancet. Infectious diseases · 2022Trial
- Trial
- Development of a Disease-Specific Virtual Malaria Population for Physiologically-Based Pharmacokinetic Modeling.CPT: pharmacometrics & systems pharmacology · 2026Article
- Impact of intensive control on malaria population genomics under elimination settings in Southeast Asia.Nature microbiology · 2026Article
- Functional assessment of prevalentmBio · 2026Article
- Parasitological efficacy of seasonal malaria chemoprevention in Nampula, northern Mozambique.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2026Article
- Re-emergence of malaria in Karen State, Myanmar: has the battle of Burma been lost?Malaria journal · 2026Observational
- Single-cell transcriptional changes of artemisinin-sensitive K13Frontiers in cellular and infection microbiology · 2026Article
- Assessing the threat of artemisinin resistance: seasonal and ecological patterns ofFrontiers in cellular and infection microbiology · 2026Article
- A genomic toolkit for surveillance and elimination of the principal malaria vectors in Southeast Asia.bioRxiv : the preprint server for biology · 2025Article
- Multiplex long-amplicon sequencing for comprehensive molecular surveillance of Plasmodium falciparum resistance to artemisinin and partner drugs in artemisinin-based combination therapies (ACTs).Parasites & vectors · 2025Article
- Investigating the Abbott-Bioline™ malaria antigen Pf/Pv rapid diagnostic test.Malaria journal · 2025Article
- Review
- Molecular Profiles of Antimalarial Drug Resistance inMicroorganisms · 2025Article
36 more citing papers are in PubMed but not listed here.
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Authors and funding
46 authors at 14 institutions in 5 countries.
Funding
Abstract
backgroundThe Greater Mekong subregion is a recurrent source of antimalarial drug resistance in Plasmodium falciparum malaria. This study aimed to characterise the extent and spread of resistance across this entire region between 2007 and 2018.
methodsP falciparum isolates from Myanmar, Thailand, Laos, and Cambodia were obtained from clinical trials and epidemiological studies done between Jan 1, 2007, and Dec 31, 2018, and were genotyped for molecular markers (pfkelch, pfcrt, pfplasmepsin2, and pfmdr1) of antimalarial drug resistance. Genetic relatedness was assessed using microsatellite and single nucleotide polymorphism typing of flanking sequences around target genes.
findings10 632 isolates were genotyped. A single long pfkelch Cys580Tyr haplotype (from -50 kb to +31·5 kb) conferring artemisinin resistance (PfPailin) now dominates across the eastern Greater Mekong subregion. Piperaquine resistance associated with pfplasmepsin2 gene amplification and mutations in pfcrt downstream of the Lys76Thr chloroquine resistance locus has also developed. On the Thailand-Myanmar border a different pfkelch Cys580Tyr lineage rose to high frequencies before it was eliminated. Elsewhere in Myanmar the Cys580Tyr allele remains widespread at low allele frequencies. Meanwhile a single artemisinin-resistant pfkelch Phe446Ile haplotype has spread across Myanmar. Despite intense use of dihydroartemisinin-piperaquine in Kayin state, eastern Myanmar, both in treatment and mass drug administrations, no selection of piperaquine resistance markers was observed. pfmdr1 amplification, a marker of resistance to mefloquine, remains at low prevalence across the entire region.
interpretationArtemisinin resistance in P falciparum is now prevalent across the Greater Mekong subregion. In the eastern Greater Mekong subregion a multidrug resistant P falciparum lineage (PfPailin) dominates. In Myanmar a long pfkelch Phe446Ile haplotype has spread widely but, by contrast with the eastern Greater Mekong subregion, there is no indication of artemisinin combination therapy (ACT) partner drug resistance from genotyping known markers, and no evidence of spread of ACT resistant P falciparum from the east to the west. There is still a window of opportunity to prevent global spread of ACT resistance.
fundingThailand Science Research and Innovation, Initiative 5%, Expertise France, Wellcome Trust.
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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.