Chlorproguanil-dapsone (LAPDAP) for uncomplicated falciparum malaria.
The synergistic antifolate combination of chlorproguanil with dapsone (CPG-DDS; LAPDAP) is being developed by a public-private partnership as a low-cost treatment for uncomplicated falciparum malaria. LAPDAP is rapidly eliminated from the body, giving it low selection pressure for drug resistance. Clinical cases with sulphadoxine-pyrimethamine (SP)-resistant infections acquired in Africa have been predicted to be responsive to LAPDAP, and clinical evidence is available to support this. A regulatory dossier is being prepared for simultaneous submission to the UK Medicines Control Agency and African licencing authorities. The team working on LAPDAP has also started to develop the triple combination of chlorproguanil-dapsone-artesunate (CDA) as a low-cost combination therapy for uncomplicated falciparum malaria. Although LAPDAP does not have regulatory approval (and development of CDA is at an early stage), the development team is keen to communicate with public health scientists to try to anticipate the policy and implementation hurdles that lie ahead. This short paper outlines the current stages that LAPDAP and CDA have reached, and sketches the anticipated public health issues.
Winstanley
P
P
Department of Pharmacology and Therapeutics, University of Liverpool, UK. peterwin@liv.ac.uk
D000962:Antimalarials / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D037621:Artemisinins; D017326:Clinical Trials, Phase III as Topic; D003622:Dapsone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017277:Drug Approval / Q000191:economics / Q000331:legislation & jurisprudence; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D002727:Proguanil / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use*; D012717:Sesquiterpenes / Q000627:therapeutic use
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; C519882:chloroguanil, dapsone drug combination; C007030:chlorproguanil; D003622:Dapsone; C031327:artemisinin; D002727:Proguanil