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The Tracking Resistance to Artemisinin Collaboration II (TRACII) study has begun recruitment, with about 180 subjects enrolled to date in 12 sites in seven countries in Asia and Africa, researchers announced at the second TRACII investigators’ meeting held 7 March in Bangkok.

Scientist operating a microscope

17 March 2016, Bangkok – The Tracking Resistance to Artemisinin Collaboration II (TRACII) study has begun recruitment, with about 180 subjects enrolled to date in 12 sites in seven countries in Asia and Africa, researchers announced at the second TRACII investigators’ meeting held 7 March in Bangkok.

In 2014, the first TRAC study confirmed that resistance of falciparum malaria to the world’s most effective antimalarial drug, artemisinin, was widespread in Southeast Asia. Health experts fear that artemisinin resistant parasites will spread from their original Cambodian-Thai border epicentre in Southeast Asia and emerge on the Indian subcontinent and then sub-Saharan Africa, putting millions of lives at risk.

Coordinated by the Mahidol Oxford Tropical Medicine Research Unit (MORU) the TRACII study investigates the efficacy, safety and tolerability of triple artemisinin combination therapies (TACTs), which consist of a rapidly acting artemisinin derivative in combination with two slowly eliminated antimalarial partner drugs.

“Falciparum malaria is becoming almost untreatable in the region and new antimalarials are years away. TACTs combining existing antimalarial drugs may prove to be our most important remaining treatment option,” said Prof. Arjen Dondorp, Head of Malaria at MORU and principal investigator of TRACII, at the meeting.

Artemisinin resistance selects for resistance toward the partner drug, causing alarmingly low cure rates with artemisinin-based combination therapies (ACTs) in several countries of the Greater Mekong Sub-region. Deploying TACTs, which combine three drugs rather than two drugs as in conventional ACTs, might be an important treatment solution. 

“The TACTs that are currently assessed in TRACII are a combination of DHA-piperaquine plus mefloquine in Cambodia, Vietnam, Thailand and Myanmar and a combination of artemether-lumefantrine plus amodiaquine in Laos, Myanmar, Bangladesh, India and the Democratic Republic of the Congo. In total the TRACII project will enrol 2,040 subjects in 17 study sites in these eight countries,” said Dr Rob van der Pluijm, TRACII project coordinator.

In addition to discussions on the core study, TRAC II collaborators from the London School of Hygiene and Tropical Medicine (LSHTM), Institut Pasteur and the Armed Forces Research Institute of Medical Science (AFRIMS) presented preliminary results and future plans for their own TRACII related projects at the annual meeting.

“The TRAC studies are possible thanks to contributions from many regional and international partners,” said Dr Mehul Dhorda, head of the Asia Regional Centre & EQA Programme, WorldWide Antimalarial Resistance Network (WWARN). “The harmonised protocols and procedures being used for these studies will allow us to track resistance and directly compare data generated over time in disparate locations across the Greater Mekong Subregion.”

TRACII is funded by the United Kingdom Department for International Development (DFID).

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