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  • 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

    Using Multiple First-Line TherapiesAgainst MalariaSlide Number 4Slide Number 5Slide Number 6Slide Number 7Using more drugs is advantageous.Treatment Strategy ComparisonTreatment Strategy ComparisonAdvantages of Deploying MFTBiological Cost of ResistanceBiological Cost of ResistanceImportant ParametersSurveillanceSlide Number 16Thanks