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[e-med] Un « nouveau » traitement contre le paludisme ?

E-MED: Un « nouveau » traitement contre le paludisme ?
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Un « nouveau » traitement contre le paludisme ?

Les laboratoires GLAXO SMITH KLINE et l'OMS viennent de signer un accord
pour le développement d?une nouvelle association thérapeutique contre le
paludisme (information OMS, 2 mars 2001).

Le LAPDAP est une association de deux composés antimalariques : le
chlorproguanil et la dapsone.  Ce médicament sera destiné à traiter les cas
de paludisme non-compliqué, en priorité dans les pays d?Afrique
sub-saharienne.  Des essais cliniques, conduits en Afrique, ont démontré une
efficacité contre les souches de Plasmodium falciparum résistantes à la
chloroquine et au Fansidarâ (sufadoxine / pyriméthamine).  Le LAPDAP
pourrait être disponible en Afrique l?année prochaine.

Le chlorproguanil est un antifolinique de la famille des biguanides connu
depuis longtemps pour son action contre le paludisme.  Comme tous les
antifoliniques, ce composé entraîne des résistances rapides dont les
mécanismes ont été bien identifiés.

La dapsone est un antifolique de la famille des sulfones, et se retrouve
déjà en association avec la pyriméthamine (autre antifolinique) dans le
Maloprimâ, utilisé par les anglo-saxons.

Les résistances associées aux antifoliques ou antifoliniques font appel aux
mêmes mécanismes biochimiques.  Nous pouvons donc nous attendre logiquement
à une durée de vie relativement courte du LAPDAP dans les pays où il sera
utilisé et où les thérapies basées sur la pyriméthamine (Fansidarâ ou
Maloprimâ) sont déjà inefficaces dans le traitement du paludisme.

 Nous pouvons nous poser plusieurs questions sur les raisons qui ont poussé
ces deux laboratoires à proposer ce type d?association.  L?absence d?un
développement rationnel de nouvelles molécules efficaces contre les souches
multirésistantes de Plasmodium falciparum peut expliquer que c?est encore
dans les vieux pots que l?on fait la meilleure soupe.

Pascal MILLET
ReMeD
Pascal.millet@u-bordeaux2.fr

**********************

e-drug : GlaxoSmithKline and WHO sign agreement
---------------------------------------------
cross posted from Afronets with thanks.
Source: International Public HealthWatch
http://www.ldb.org/iphw/index.htm

Press Release WHO/10 2 March 2001

GLAXOSMITHKLINE AND WORLD HEALTH ORGANIZATION SIGN AGREEMENT TO
DEVELOP A NEW TREATMENT FOR MALARIA

GlaxoSmithKline and the World Health Organization (WHO) today
announce that they have signed an agreement for the development of a
new treatment for malaria called LAPDAP.

LAPDAP, a product that combines two existing anti-malarial compounds
chlorproguanil and dapsone, is a potential life-saving medicine. The
aim of the agreement is to develop LAPDAP as an effective oral
treatment for uncomplicated malaria, primarily for use in Sub-Saharan
Africa, but also in other regions of the world where this may be
appropriate. To date, clinical trials in Sub-Saharan Africa have
demonstrated that LAPDAP is effective in the treatment of
uncomplicated malaria including malaria resistant to other standard
first line therapies such as chloroquine and
sulphadoxine/pyrimethamine (SP).

LAPDAP will be made available at a preferential price for public
health programmes. The medicine is already entering its final phase
of development and could be available in some African countries as
early as next year.

Both partners have contributed towards the costs of product
development and have set up a joint team to oversee the development
of the
product. Other important supporters of this initiative include the UK
Department for International Development (DfID) and the University of
Liverpool, UK.

"GlaxoSmithKline firmly believes that the complex issues associated
with meeting the healthcare needs of developing countries will only
be resolved through collaborative effort," said Jean-Pierre Garnier,
Chief Executive Officer, GlaxoSmithKline.

"The LAPDAP programme further demonstrates this new company's
determination to play its part in improving healthcare world-wide and
in
finding innovative and practical ways of providing much needed new
medicines to people in developing countries."

Dr Gro Harlem Brundtland, Director General of the World Health
Organization said: "Drug resistance means that large populations in
many parts of the world are without protection from malaria. LAPDAP
will be an important help in reducing the burden of malaria among
those living in Sub-Saharan Africa and elsewhere. This agreement
shows that public-private partnerships can achieve important
practical results. It is an important collaboration not only because
it
will bring a new drug to the market, but also because it includes a
price structure that aims at making the drug affordable for those who
need it."

WHO, by means of its UNDP/World Bank/WHO Special Programme for
Research and Training in Tropical Diseases (TDR), is arranging and
providing considerable financial support for clinical trials of
LAPDAP.
In addition, WHO is making available its technical expertise,
especially in the area of malaria clinical trials, to the development
team. TDR's expertise and the knowledge and experience of the WHO-led
"Roll Back Malaria" partnership will also be available as the
programme proceeds beyond regulatory approval.

GlaxoSmithKline will be responsible for product registrations and
manufacture of LAPDAP. The company will also commercialise the
product in the private sector according to standard local market
practice.

The UK Department for International Development (DfID) provided
funding to advance the project while the University of Liverpool, UK,
devised the concept of LAPDAP in the early 1990s, and have continued
to be major contributors to the programme. The Product Development
Team
is chaired by Professor Peter Winstanley of The University of Liverpool.

The partnership intends to extend their collaboration to develop
LAPDAP in combination with an artemisinin derivative, in order to
extend further the useful life of the new medication.

Malaria is a serious, sometimes fatal, disease. At least 300 million
clinical cases occur world-wide every year, 90 percent of which are
in Africa. Every day close to 3000 people, mostly children under
five, die as a result of this disease.

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