TropIKA.net coverage

• Meeting home
• Meeting news
• Interviews
• Daily Reports
  • Monday 2 November
  • Tuesday 3 November
  • Wednesday 4 November
  • Thursday 5 November
  • Friday 6 November
• Session reports
• Profiles
• Meeting blog
• Social calendar
• Event photos

WorldWide Antimalarial Resistance Network, WWARN: First Steps toward realization

Source: TropIKA

Title of the session: WorldWide Antimalarial Resistance Network, WWARN: First Steps toward realization

Date: 3rd November 2009

Agenda item: Symposium 19

Session theme: Antimalarial resistiance Network, WWARN: First steps toward realization

Meeting room: Tsavo Ballroom 2

Chair(s): Professor Carol Sibley, WWARN Scientific Director, University of Oxford, UK and University of Washington, Seattle, USA

Presenters:

• Dr. Hasifa Bukirwa, Makerere University, Kampala, Uganda
• Fraction Dzinjalamala, University of Malawi, College of Medicine, Blantyre, Malawi
• Allen Malisa, Sokoine University of Agriculture, Morogoro, Tanzania
• Phillipe Guerin, WWARN Executive Director, University of Oxford, UK

TropIKA rapporteur: Faith Apolot Okalebo

Major topics:

• Tools for management of clinical drug efficacy data
• Pharmacology: a key component of assessment of drug efficacy
• Molecular tools for surveillance of drug efficacy
• Integrated information on antimalarial resistance.

Keywords: WorldWide Antimalarial Resistance Network

Scope: Translational research

REPORT ON ORIGINAL SESSION

Overview

The WorldWide Antimalarial Resistance Network (WWARN) is a collaborative network of researchers involved in understanding causes of treatment failure in malaria. Causes of treatment failure include drug resistance, inadequate drug plasma levels and poor adherence. WWARN was formed about one year ago to meet the problems of lack of quality data, no forum for sharing data generated and lack of uniformity of study protocols. To facilitate sharing of information, WWARN has a database to allow researchers and National Malaria Prevention and Control programs to key in information. WWARN aims to collect information on: clinical studies for efficacy; prevalence of molecular markers for drug resistance; pharmacokinetic studies on drug levels in blood; and in vitro drug susceptibility studies. Already, a numbers of researchers are providing raw data. This data can be used to synthesize evidence to inform policy makers on resistance patterns and optimal dosing regimens. In addition WWARN provides information to researcher on standardized research protocols and data analytic tools.

This session had four speakers. Two speakers spoke about their experience with using of tools available on the WWARN database. They reported that these tools are easy to use and had a positive impact on their research. A third speaker made a case for inclusion of pharmacokinetic studies in clinical trials for efficacy. He provided evidence for the need for a more integrated approach in evaluating evidence and studies for lack of drug effectivess. The last speaker dwelt on the objective of the WWARN network, its goals and its future plans. WWARN intends to increase the number collaborating researchers.

CONTEXT AND ISSUE

Treatment failure in malaria management may be due to a number of factors such as drug resistance, poor drug quality, poor adherence and inappropriate doses. However there is lack of quality information to inform policy makers why treatments fail and ways in which these problems can be solved. Information that can shed light on causes of treatment failure can be obtained from: clinical trials of efficacy of drugs; surveillance for molecular markers of drug resistance ; in vitro studies for drug susceptibility; and population pharmacokinetic studies to determine whether adequate plasma drug levels are achieved. One speaker from Malawi presented evidence that children under 12 have inadequate blood levels of antimalarial drugs such as lumefantrine and sulphadoxine and pyrimethamine. However while there are a lot of studies that are going on to determine reasons for treatment failure, there is a lot of non-uniformity in terms of study protocols, methodology, data analysis and data storage. Often researchers lack tools to adequately analyze the data as was reported by a researcher from Uganda. There is no mechanism to share this data and use it to inform policy makers at regional and international level. WWARN was formed to address these shortcomings. Its goals are to provide a forum for data sharing in a database that that collects data that can use integrated to provide early warning of emerging drug resistance; pharmacokinetic information that can optimize drug dosing; and clinical studies of drug efficacy. It also aims to provide tools for analysis and provide researchers with standardized study protocols.

Initiatives on the ground; experience/s derived

A researcher from Uganda gave her experience of process of refining her data base so that it could meet the requirements of the WWARN database. She reported that the process was simply and straight forward. She reported that she used tools from the WWARN website to improve analysis of her data and was satisfied with the results. In Tanzania, a researcher has been supplying raw data on the prevalence of various molecular markers of resistance to sulphadoxine and pyrimethamine. Interestingly he observed that despite switching to ACT the prevalence of genetic marker for resistance to these two agents has continued to rise. A member of the audience from CDC reported that she has used tools from the website to analyase data obtained from in vitro drug susceptibility studies with excellent results. Researcher in South Africa and Malawi are feeding the database with pharmacokinetic data.

Lessons learned

Users of the website report that they have had a satisfactory experience and harmonization of the data management protocol is easy.

Issues raised, obstacles, difficulties

The audience noted that there are no validated markers for resistance to artemisinin and WWARN needs to advise on this. Secondly, with regard to in vitro drug susceptibility testing there are no standard high quality pure drug for use during testing.

Future plans

WWARN hopes to continue refining and updating its tools and standard protocols. However more researchers need to be recruited to provide raw data for evidence synthesis. This will be done by directly contacting researchers all over the world by adverstisments and through conferences. WWARN is working with WHO to mobilize National Malaria Programs to provide raw surveillance data to the database.

FINDINGS AND CONCLUSIONS

WWARN is a promising mechanism for harmonization and standardization of research methods, sharing of data and synthesis of evidence to aid policy makers. However more awareness needs to be created so that more scientists can provide data.

From formal presentations

Public health Implications

The final speaker made a case for a more integrated and collaborative approach for evaluation of research data and evidence and well as harmonization of study protocols.

Policy Impact

WWARN is likely to provide evidence for policy makers on dose selection and early warning of emerging resistance.

Translational Research Impact

WWARN highlights that there is need in incorporate pharmacokinetic studies during routine clinical studies for drug resistance.

Main points of divergence

Researchers may not be willing to share information and this should be left at their discretion.

Personal observations from rapporteur

This seems to be a very promising initiative. However researchers in Africa are often skeptical about sharing data. The audience was very enthusiastic about the initiative. The success of this initiative is dependent on its collaboration with WHO.

Comments