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Using Multiple First-Line TherapiesAgainst Malaria
Antimalarial TreatmentStrategies Conference
March 31 2008
Maciej F Boni
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combinationtherapy
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combinationtherapy
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combinationtherapy
multiplefirst-linetherapies
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combinationtherapy
multiplefirst-linetherapies
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Using more drugs is advantageous.
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Bergstrom et al (2004)
Treatment Strategy Comparison Effect #1
pathogen experiencesless variable environment
Multiple First-Line Therapies
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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
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Advantages of Deploying MFT
1. Delays emergence of resistant strains.
2. Slows down spread of resistance.
3. Reduces clinical burden and failed treatments.
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Biological Cost of Resistance
Kublin et al (2003)
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Biological Cost of Resistance
Kublin et al (2003)
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Important Parameters
1. fraction of cases treated2. biological cost of resistance3. length of evaluation period4. EIR5. inbreeding coefficient
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Surveillance
time
Hastings et al (2007)
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Surveillance
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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