The Liverpool School of Tropical Medicine (LSTM) has found that the new drug dihydroartemisinin-piperaquine (DP) may be a promising alternative in malaria treatments for pregnant women.
While the trial of the new medicine did well in an intermittent preventative treatment approach, the so-called ‘test and treat’ approach of administering the medicine was somewhat disappointing.
While use of the test and treat approach limits the drug to those pregnant women most likely to benefit from the medication -- and while the test for malaria can be grouped with other standard pregnancy tests -- this approach has still not performed as well as expected in clinical trials.
“The concept of test and treat approaches is attractive, especially for the control of infectious diseases in pregnancy,” Dr. Feiko ter Kuile, a professor at LSTM, said. “However the performance of test and treat approaches is highly dependent on the performance of the diagnostic test used.”
And while it is true that the world of malaria testing has changed dramatically in recent years with innovations in Rapid Diagnostic Testing for Malaria using the so-called dipstick test, these tests were designed to diagnose those who already were showing symptoms for malaria. Asymptomatic carriers of the disease typically have a much lower parasite count and are thus harder to identify through these methods.
The underperformance of the test and treat method, argues Kulie, is a failure of the current rapid diagnosis tools to identify asymptomatic carriers, and not a failing with the medicine itself. Running the study again when better diagnostic tools become available will likely yield a different result.
“There is a lot of research going on to develop these tests as part of the malaria elimination research and product development agenda, and the control of malaria in pregnant women could benefit from that momentum,” Kulie said.
As for DP itself, the drug is important to combating malaria. Full findings from the study were published in The Lancet.