Last week in Malaria World there were two articles about the resistance of malaria to artemisin derived treatments. Artemisinin-resistant malaria in Africa demands urgent action by Dhorda et al and Immediate policy changes urgently needed as drug-resistant malaria spreads in East Africa from the Centre of Tropical Medicine and Global Health.
The core of the research, sponsored by the Wellcome Trust, is that the efficacy of artemisinin derivatives, the cornerstone of current treatments for malaria, is being compromised in Africa. Mutations indicating artemisinin-resistance have been found in more than 10% of malaria infected individuals in Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania. Dr Mehul Dhorda recommends that “Combining an artemisinin derivative drug with two partner drugs in triple artemisinin combination therapies (TACTs) is the simplest, most affordable, readily implementable, and sustainable approach to counter artemisinin resistance.”
Typically, triple artemisinin combination therapies (TACTs) are extra combinations such as artemether-lumefantrine with amodiaquine, and dihydroartemisinin-piperaquine with mefloquine. More details are in Kokori et al Malaria Journal article (2024) Triple artemisinin-based combination therapy (TACT): advancing malaria control and eradication efforts.
The Kokori article goes to great length to extol the benefits of three treatments together instead of one but the evidence does not seem very convincing. They note that adding mefloquine or amodiaquine to existing artemisinin-based combinations was associated with a slight increase in the incidence of vomiting. And adding amodiaquine slightly prolonged the QTc interval (a measure of the heart’s electrical activity), although it did not reach levels associated with cardiac arrhythmias. And as for efficacy, TACT was not inferior to ACT for treating uncomplicated Plasmodium Falciparum malaria!
Also, coincidentally this week I saw for the first time a tweet associating artemisinin with detoxification of COVID-19 vaccines (and also as a treatment for COVID). This information from China is interesting. I have no reason to suspect that it is any more effective at treating these than it is at treating malaria, but if were suffering seriously from the side-effects of you know what I might be inclined to try it.