rewrite this title New malaria drug could be a life-saver as the standard drug shows signs of weakness

At the turn of the millennium, a new class of drugs derived from ancient Chinese herbal medicine revolutionized malaria care. Artemisinin’s, as they’re called, are based on extracts from the sweet wormwood plant. They arrived just as the drugs used since the 1970s were becoming useless for many, as the parasite that causes malaria evolved resistance.

“The deaths we saw in the late 1990s, the early 2000s — like 2 million a year — that was a direct result of drug failure,” says George Jagoe, executive vice president of access and product management at Medicines for Malaria Venture, a non-profit. “No one ever wants to be behind the 8-ball again.”

Artemisinins have saved millions of lives since then and are now the foundation of malaria treatment worldwide. But there are worrying signs that these drugs are following in the footsteps of their predecessors. To prevent history from repeating itself, new drugs that target the malaria parasite differently are required, says Jagoe.

“I would call it being ready, having a fire extinguisher in the back that you’re ready to use, but maybe not necessarily deploying, versus the house catches on fire and you’ve got nothing,” says Jagoe.

After more than two decades, researchers are on the cusp of having that fire extinguisher.

A new drug, called GanLum, was more than 97% effective at treating malaria in clinical trials carried out across 12 African countries, researchers reported Wednesday at the American Society for Tropical Medicine and Hygiene in Toronto. That’s as good, if not better, than the current standard of treatment. If approved by regulators, it could be a powerful new tool against a disease that kills roughly half a million people each year.

“It’s a big deal,” says Kasturi Haldar, a biologist at the University of Notre Dame who has studied malaria for decades and was not involved in this study. “It’s also pretty timely.”

That’s because of artemisinin resistance. First discovered in southeast Asia in the late 2000s, it’s recently spread to the continent hardest hit by malaria. “Partial artemisinin resistance has been spreading quite aggressively across many parts of Africa,” says David Fidock, a microbiologist at Columbia University who wasn’t involved in the study. “We’ve been sounding the alarm that we must have new drugs to deploy, should resistance lead to treatment failure. [GanLum] will help stem that significantly.”

GanLum stands for ganaplacide/lumefantrine, a combination of two drugs, one new and one old (most antimalarial treatments are combinations of drugs, to target the parasite at different stages of infection). The new one, ganaplacide, was discovered by scientists at Novartis after screening over 2.3 million molecules for antimalarial properties. It seems to work by disrupting the malaria parasites’ ability to live inside human red blood cells.

In the lab, the researchers showed it could kill all known forms of the parasite, including those with mutations linked to artemisinin resistance. It also attacks the stage of the parasite that’s responsible for transmission. “That is very desirable for a drug to have,” says Haldar, since it can prevent the spread, in addition to just treating the patient.

In clinical trial settings, the drug performed well too.

The research team enrolled over 16,000 adults and children over 2 years old with malaria across a dozen countries in Africa. Half took GanLum over the course of three days and half got the current artemisinin-based standard of care. The team found both drugs were about equally effective, with GanLum coming out slightly on top. Both drugs had similar levels of side effects, including nausea and diarrhea. But the GanLum group did experience more vomiting.

The drug still needs to clear additional regulatory hurdles before it gets to patients. The team thinks that’ll take about a year and a half. Even if it’s approved and rolled out, GanLum likely won’t be fully replacing artemisinin-based treatments anytime soon, since arteminisin-based treatments still work in many areas. “But at this point, it looks good enough that it could be used where there’s a lack of responsiveness to the current [artemisinin-based] drugs,” says Haldar.

Ultimately, that could prolong the lifespan of both drugs, and help countries avoid the kind of surge in deaths that’s happened when resistance overwhelms existing tools.