E-drug: Lapdap: a new antimalarial for Africa
---------------------------------------------------------------------
[From TDRNews, 70, October 2003. Full contents of this month's and
earlier issues at www.who.int/tdr/publications/tdrnews/default.htm .
Anyone interested in regular hard copies of this great (and free) jour-
nal, please send an e-mail to tdr@who.int . Copied as fair use. HH]
Lapdap: a new antimalarial for Africa
A new antimalarial treatment, a combination of chlorproguanil and
dapsone known as 'Lapdap', which was developed by TDR and
partners, has been approved by the UK Medicines and Healthcare
Products Regulatory Agency (MHRA) for the treatment of
uncomplicated Plasmodium falciparum, the most life-threatening
malaria parasite, in adults and children more than three months of
age. Lapdap is effective against drug-resistant parasites and is
anticipated to be available in several African countries by the end of
2003, assuming that national approval is granted.
Affordable new antimalarials are badly needed in subSaharan Africa,
where first-line treatments (e.g. chloroquine,
sulphadoxine/pyrimethamine) are failing due to increasing parasite
resistance. Lapdap is cheap to produce and has a short half-life,
presenting a smaller 'window' for selection of resistance than drugs
with a longer half-life, so the antimalarial efficacy should be retained
for longer.
The safety and effectiveness of Lapdap will now be further assessed
through surveillance of phase IV trials; so far, in the phase III clinical
programme in sub-Saharan Africa, the most common adverse effect
was anaemia, which occurred in only a small proportion of patients
and was of limited duration.The safety of Lapdap will also be
assessed in specific patient groups, e.g. very young children, preg-
nant women, those co-infected with HIV, those with a predisposition
to certain kinds of anaemia. Since chlorproguanil-dapsone is pharma-
cologically similar to sulphadoxine/pyrimethamine, further work is also
needed to understand how the useful therapeutic life of
chlorproguanil-dapsone will be affected by the growing resistance to
S/P.
To what extent chlorproguanil-dapsone will, by itself, find use in the
treatment of malaria is, however, uncertain WHO strategy is to use
new antimalarial drugs in combination with an artemisinin derivative,
and Lapdap has the potential to be used in this way as a 'loose'
combination with an artemisinin. The development of a fixed-dose
combination of Lapdap with artesunate (chlorproguanil-dapsone-
artesunate or CDA) is already under way and is currently undergoing
phase II clinical trials in Malawi. The creation of a public-private
partnership to further develop this combination drug is at an advanced
stage of negotiation.
Tom Kanyok
TDR/PRD
WHO Geneva, Switzerland
Tel.: (+41 22) 791 3684
Fax: (+41 22) 791 4954
E-mail: kanyokt@who.int
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug