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New antimalarial drugs are urgently needed due to Plasmodium falciparum resistance. Several promising agents are in clinical development, including novel combinations and treatments for severe malaria and relapse prevention.

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Area of Science:

  • Drug Discovery and Development
  • Infectious Diseases
  • Parasitology

Background:

  • Antimalarial drug development has accelerated, driven by product development partnerships.
  • Emerging resistance to artemisinin derivatives, piperaquine, and mefloquine in Southeast Asia necessitates urgent development of new antimalarials.
  • The malaria burden is predicted to remain high, underscoring the continuous need for novel therapeutic agents.

Purpose of the Study:

  • To review the current landscape of antimalarial drug development.
  • To highlight key agents in clinical trials for uncomplicated and severe malaria, and for Plasmodium vivax relapse prevention.
  • To discuss the challenges and future directions in antimalarial combination therapy.

Main Methods:

  • Review of current antimalarial agents in clinical development.
  • Analysis of leading candidates in various phases of clinical trials.
  • Discussion of challenges including drug resistance and specific population use.

Main Results:

  • Over 13 antimalarial agents are in clinical development, primarily blood schizonticides for uncomplicated falciparum malaria.
  • Artefenomel-ferroquine and lumefantrine-KAF156 are leading candidates in Phase 2b.
  • Tafenoquine is under regulatory review for Plasmodium vivax relapse prevention, offering a single-dose alternative to primaquine.

Conclusions:

  • New antimalarials are crucial due to widespread resistance and the persistent malaria burden.
  • Current treatment for severe malaria relies on artesunate and quinine, with sevuparin as an adjuvant.
  • Future strategies may involve three- or multi-drug combinations to combat resistance and improve treatment efficacy.