Staff from Queen Elizabeth Hospital, Kota Kinabalu, Sabah State Health Department and Clinical Research Centre (CRC), together with international collaborators have successfully conducted the first clinical trial ever on people with monkey malaria. Findings from the randomised control trial has shown that a key combination of antimalarial drugs works well in curing the infection. The study has just been published in the prestigious international journal, Lancet Infectious Diseases. The monkey parasite, an emerging infection called Plasmodium knowlesi, has become the most common cause of human malaria in Malaysia and is also found throughout Southeast Asia.
Funded by the Ministry of Health research grant, clinical researchers from the Ministry of Health Malaysia and the Darwin’s Menzies School of Health Research, worked in collaboration with a number of MOH hospital sites, community and local government stakeholders in Sabah, Malaysia to conduct this study.
While a number of different drugs have been used to treat this infection, this is the first randomised controlled trial to be conducted for uncomplicated knowlesi malaria to define the optimal treatment in both adults and children. This research led by Dr. Timothy William, the Principal Investigator for the project, Dr. Matthew Grigg, Prof. Nick Anstey and Dr. Yeo Tsin Wen compared an artemisinin-combination therapy (ACT) called artesunate-mefloquine against chloroquine to see how quickly they clear parasites in the blood. The results showed that while that both drugs were able to cure the infection, ACT was able to clear parasites and fever faster allowing earlier hospital discharge, and also reduced the risk of anaemia.
Dr Timothy William explained the importance of the study.
“The World Health Organisation only recently recommended ACT for P. knowlesi malaria in their 2015 Malaria Treatment Guidelines, however this is the first study specifically designed to provide evidence for this policy change. Because other species malaria parasites causing infection in Sabah look similar under the microscope to the monkey parasites, they are often misdiagnosed as each other. Because these other parasites are usually resistant to chloroquine, treating them with chloroquine as though they were monkey malaria can have dangerous consequences. We have now shown that all species respond well to ACT, including monkey malaria. This means we can safely use ACT for malaria caused by all the malaria species in Malaysia. These findings are groundbreaking and a significant success for the Malaysian Ministry of Health. The results will be disseminated to inform knowlesi malaria treatment policy in this region,” Dr William said.
Community and local government stakeholder meetings will be held to share the results and guide state and national treatment policy. The guideline will support a unified ACT treatment plan that covers all Plasmodium species, helping to save more lives in the Southeast Asian region.
Text Prepared by: QE Hospital & Clinical Research Centre, Ministry of Health Malaysia