Multiple First-line Therapies

If two drugs (in combination) are good, are three or more being used concurrently by different patients better at keeping drug resistance at bay? The question has practical consequences, as nearly every malaria-endemic country adopts a single first-line treatment (now, a combination drug) as policy. National policies are difficult to change and to implement in these relatively poor countries, and good evidence would be needed to adopt a more complex approach. CDDEP researchers began investigating MFT in 2006 using an evolutionary-epidemiological modeling framework. They compared MFT with single combination drugs and with cycling strategies where therapies are rotated, either on a fixed cycling schedule or when resistance levels or treatment failure become too high. Compared with these alternatives, the analysis predicts that MFT strategies will delay the emergence and slow the fixation of resistant strains.