Assessing Antimalarial Efficacy in a Time of Change to Artemisinin-Based Combination Therapies The Role of Médecins Sans Frontières 英文参考文献.docVIP

Policy Forum Assessing Antimalarial Efficacy in a Time of Change to Artemisinin-Based Combination Therapies: The Role of Médecins Sans Frontières Jean-Paul Guthmann , Francesco Checchi, Ingrid van den Broek, Suna Balkan, Michel van Herp, Eric Comte, Oscar Bernal, * Jean-Marie Kindermans, Sarah Venis, Dominique Legros, Philippe J. Guerin D uring the 1990s, high levels of Plasmodium falciparum (Pf ) resistance to common antimalarials were reported from malaria-endemic countries, raising questions about the efficacy of Summary Points SUB 3AHARANè!FRICAèWHEREèSTUDIESè represent the vast majority of available data and where “traditional” academic research institutions were not or barely represented. sè -OREèTHANèèPATIENTSèWEREè enrolled in 43 efficacy studies in 18 countries of Asia and Africa between èANDèèACCOUNTINGèFORèONEè fourth of the overall research output in these countries. chloroquine (CQ), then the mainstay of antimalarial treatment. Drug resistance was considered a prime contributing factor to increased malaria mortality and morbidity across Africa [1,2]. The natural successor to CQ, sulfadoxine-pyrimethamine (SP), had a short therapeutic lifespan [3], and the choice of an effective first-line regimen emerged as a key issue in Pf malaria control. Artemisinin-based combination therapy (ACT), adopted in southeast Asia since the early 1990s, appeared to be the best available option [3]. sè 4HEèVASTèMAJORITYèOFèTHEèSTUDIESèWEREè PUBLISHEDèINèPEER REVIEWEDèJOURNALSè which shows that research performed in difficult settings can be of a high enough standard to ensure publication and to be useful in policy change. sè 4HISèHASèPROVIDEDèEXTENSIVEèEVIDENCEè on the efficacy of most drug regimens currently in use for uncomplicated MALARIAèWHICHèWASèOFTENèUSEDèFORè treatment policy changes by the concerned countries. sè 4HISèWORKèDEMONSTRATESèTHEèPOTENTIALè role of non-governmental agencies in collecting the necessary evidence to stimulate and inform