The Daily Times of Malawi has reported that, “The Malaria Control Program has said the new malaria drug, artemisinin combination therapy (ACT)â€”commonly known as LAâ€”is the best drug against malaria, even though patients have complained of unpleasant side effects. Some patients have complained of persistent headaches and itching whilst others have said some of their body parts swell after taking the drug.” One assumes that “LA” means lumefantrine-arthemeter. In contrast in neighboring Zambia researchers found that after the new treatment policy of ACTs was introduced there were high levels of acceptability, and “it was not surprising to see high levels of compliance.”
Itching and fatigue have definitely been associated with amodiaquine. But according to Malawi’s Global Fund Round 7 Malaria Proposal, “AL (artemether- lumefantrine) was chosen over other ACTs due to its co-formulation which is expected to improve compliance while artesunate+amodiaquine (AA) was chosen as second line for the management of the uncomplicated malaria.” A recent review of ACTs by Nosten and White reported that, “except for occasional hypersensitivity reactions, the artemisinin derivatives are safe and remarkably well tolerated. The adverse effect profiles of the artemisinin-based combination treatments are determined by the partner drug.”
Just because a drug is effective, it may not be acceptable. As was found with AA in Ghana in 2005, first the drug needs to be formulated correctly. Various other factors affect acceptability including cost, packaging, provider-client communication and drug color in addition to side-effects. It is quite important to test all these factors with consumers, not just drug efficacy.
Perceived problems with drugs do interfere with compliance, and poor compliance will lead to development of drug resistance. Monitoring of acceptability and compliance must be an integral part of any malaria control program.
In the meantime there is need to keep searching for new anti-malarial drugs. That is why the news is sad that after nearly a decade’s work put into developing LapDap, the drug was ultimately pulled from the market because of links with anemia. This was a good example of public-private collaboration, and hopefully such ventures will continue.