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Open Access Highly Accessed Review

World Antimalarial Resistance Network I: Clinical efficacy of antimalarial drugs

Ric N Price12*, Grant Dorsey3, Elizabeth A Ashley4, Karen I Barnes5, J Kevin Baird6, Umberto d'Alessandro7, Philippe J Guerin4, Miriam K Laufer8, Inbarani Naidoo9, François Nosten10132, Piero Olliaro112, Christopher V Plowe8, Pascal Ringwald12, Carol H Sibley13, Kasia Stepniewska132 and Nicholas J White132

Author Affiliations

1 International Health Program, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia

2 Centre for Vaccinology & Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, UK

3 Department of Medicine, University of California, San Francisco, CA, USA

4 Epicentre, 8 rue Saint Sabin, 75011 Paris, France

5 Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa

6 ALERTAsia Foundation, Eijkman Institute for Molecular Biology, Jakarta Pusat 10430, Indonesia

7 Department of Parasitology, Institute of Tropical Medicine, Antwerp, Belgium

8 Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA

9 Malaria Research Programme, Medical Research Council, Durban, KwaZulu-Natal, South Africa

10 Shoklo Malaria Research Unit, Mae Sot, Thailand

11 UNICEF/UNDP/World Bank/WHO Special Programme on Research &Training in Tropical Diseases (TDR) World Health Organization, 20 avenue Appia, CH-1211, Geneva Switzerland

12 Global Malaria Programme (GMP), World health Organization, 20 avenue Appia, CH-1211, Geneva Switzerland

13 Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand

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Malaria Journal 2007, 6:119  doi:10.1186/1475-2875-6-119

Published: 6 September 2007

Abstract

The proliferation of antimalarial drug trials in the last ten years provides the opportunity to launch a concerted global surveillance effort to monitor antimalarial drug efficacy. The diversity of clinical study designs and analytical methods undermines the current ability to achieve this. The proposed World Antimalarial Resistance Network (WARN) aims to establish a comprehensive clinical database from which standardised estimates of antimalarial efficacy can be derived and monitored over time from diverse geographical and endemic regions. The emphasis of this initiative is on five key variables which define the therapeutic response. Ensuring that these data are collected at the individual patient level in a consistent format will facilitate better data management and analytical practices, and ensure that clinical data can be readily collated and made amenable for pooled analyses. Such an approach, if widely adopted will permit accurate and timely recognition of trends in drug efficacy. This will guide not only appropriate interventions to deal with established multidrug resistant strains of malaria, but also facilitate prompt action when new strains of drug resistant plasmodia first emerge. A comprehensive global database incorporating the key determinants of the clinical response with in vitro, molecular and pharmacokinetic parameters will bring together relevant data on host, drug and parasite factors that are fundamental contributors to treatment efficacy. This resource will help guide rational drug policies that optimize antimalarial drug use, in the hope that the emergence and spread of resistance to new drugs can be, if not prevented, at least delayed.