Using Multiple First-Line TherapiesAgainst Malaria

Antimalarial TreatmentStrategies Conference

March 31 2008

Maciej F Boni

combinationtherapy

combinationtherapy

combinationtherapy

multiplefirst-linetherapies

combinationtherapy

multiplefirst-linetherapies

Using more drugs is advantageous.

Bergstrom et al (2004)

Treatment Strategy Comparison Effect #1

pathogen experiencesless variable environment

Multiple First-Line Therapies

Bergstrom et al (2004)

Treatment Strategy Comparison Effect #2

mean fitness of pathogen population is depressed

2% res. 10% res.

resistance evolution is mucheasier for the parasite

Boni et al (2008)

Multiple First-Line Therapies

Advantages of Deploying MFT

1. Delays emergence of resistant strains.

2. Slows down spread of resistance.

3. Reduces clinical burden and failed treatments.

Biological Cost of Resistance

Kublin et al (2003)

Biological Cost of Resistance

Kublin et al (2003)

Important Parameters

1. fraction of cases treated2. biological cost of resistance3. length of evaluation period4. EIR5. inbreeding coefficient

Surveillance

time

Hastings et al (2007)

Surveillance

Thanks

Dave SmithUniversity of Florida

Ramanan LaxminarayanResources for the Future

Carl BergstromUniversity of Washington

Marc FeldmanStanford University

Hellen GelbandInstitute of Medicine and Resources for the Future

Eili KleinResources for the Future and Princeton University

Mike EberResources for the Future

Bill and Melinda Gates Foundation