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Clinic in Bamako, Mail

Study groups

WWARN facilitates a number of collaborative Study Groups to undertake individual patient data meta-analyses to answer specific research questions about malaria drug resistance. Gathering data sets from multiple studies increases sample sizes, so that trends or sub-population effects can be identified with greater certainty. Working together and combining data from different regions and populations is improving our understanding of drug resistance and strengthening global efforts to control and eventually eliminate malaria.

Clinical Trials Methodology Study Group for P. falciparum

This Study Group is exploring key study design and analytical factors which affects derived clinical efficacy of antimalarials. 
Statistical analyses have commenced and preliminary results of ongoing analyses will be shared at EDCTP Forum 2016 (Lusaka, Zambia) and ASTMH 2016 (Atlanta, USA). Publications are expected in 2018.

Vivax Haematology Study Group

Analysis of the consequences of symptomatic Plasmodium vivax infections on anaemia before and after antimalarial treatment 

DRC Healthcare centre
Piperaquine Safety Study Group

The Piperaquine Safety Study Group’s aim is to establish the evidence-base and safety profile to inform decision-making on the use and optimal dosing of dihydroartemisinin-piperaquine in all key target populations.
The study group call for contributors opened in June 2016 with a first scoping meeting held in July. Data collection is planned to close by end of 2016, with analysis due at the end of 2017.

Lumefantrine – ARV PK/PD Study Group

An analysis of pooled individual patient data to determine the effect of antiretroviral (ARV) drug-drug interactions and HIV disease on lumefantrine pharmacokinetics (and pharmacodynamics).
This study group has just opened for data collection. If you have any data you would like to share, or if you would like to participate in the project, please contact pharmacology [at] wwarn [dot] org.

Gametocyte
Low-dose Primaquine Efficacy and Safety Study Groups

Pooled analyses of the efficacy and safety of single low-dose primaquine to interrupt P. falciparum malaria transmission.
Data collection has closed and curation is ongoing. Analysis and draft publications are planned for circulation to the Group by the June of 2017.

AS-MQ Dose Impact Study Group

A pooled analysis assessing the effect of mg/kg dosing strategies on the risk of treatment failure in patients treated with the currently recommended dose of artesunate-mefloquine (AS-MQ).
Research groups with relevant data have been contacted with data collection and curation still ongoing. Analysis will start in late 2016 and drafting publication in expected in 2018.

Red blood cells
Haematology Study Group

Analysis of haematological response before and after antimalarial treatment
A pooled analysis to understand the normal haematological response and recovery following the treatment of uncomplicated malaria. The group will work together to quantify the risks and benefits of different treatment options of both ACTs and other antimalarials.
Data gathering and curation has started. Data meeting the inclusion criteria has already been collected and standardised from over 70,000 patients. Data analysis was conducted in 2015 with publication in discussion 2017-2018.

Woman receiving medication from nurses
AS-AQ Post-Treatment Prophylaxis Study Group

Modelling the protective effect of Artesunate-Amodiaquine (AS-AQ)
A pooled analysis to assess the post-treatment prophylactic effect of artesunate-amodiaquine (AS-AQ). The group is quantifying the duration of post-treatment prophylaxis mediated by AS-AQ and how it depends on host factors such as .
The Study Group closed in January 2014. The AS-AQ Post-Treatment Prophylaxis Study Group manuscript is currently being finalised and will be submitted soon.

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ASAQ treatment
AS-AQ Dose Impact Study Group

Effect of AS-AQ mg/kg dosing strategies on the risk of treatment failure
A pooled analysis to assess the impact of weight adjusted (mg/kg) dose variations of artesunate-amodiaquine (AS-AQ) on therapeutic efficacy of both drugs combined. The Study Group assessed if the dose of amodiaquine administered to the patients was a risk factor for recrudescence(recurrence of symptoms). The results are expected to be published in the BMC Medicine at the end of March 2015.
The study group closed in March 2013. The paper was published in March 2015. 
Publiction details: 
The Worldwide Antimalarial Resistance Network (WWARN) AS-AQ Study Group. The effect of dosing strategies on the therapeutic efficacy of artesunate-amodiaquine for uncomplicated malaria: a meta-analysis of individual patient data. BMC Medicine 2015 13:66. Published 31 March 2015 doi: 10.1186/s12916-015-0301-z.

Finger-prick for malaria blood slide
Parasite Clearance Study Group

Parasite clearance after treatment with an artemisinin monotherapy or ACT
This Study Group characterises parasite clearance stratified by location, treatment and time and to find optimal restricted sampling schemes for clearance estimation and provides baseline information on parasite clearance.
The latest study, ‘Baseline parasite clearance data in uncomplicated falciparum malaria after treatment with an artemisinin derivative alone or in combination’, has been submitted to Malaria Journal and is currently under review.
Related publications:
Flegg JA, Guerin PJ, Nosten F et al. Optimal sampling designs for estimation of Plasmodium falciparum clearance rates in patients treated with artemisinin derivatives. Malaria Journal, 2013. Doi: 10.1186/1475-2875-12-411.  PMID: 24225303
WWARN Parasite Clearance Study Group ‘Baseline data of parasite clearance in patients with falciparum malaria treated with an artemisinin derivative: an individual patient data meta-analysis’ Published in Malaria Journal 2015. DOI:10.1186/s12936-015-0874-1

Alignment of DNA sequences
AS-AQ/AL Molecular Marker Study Group

Role of candidate molecular markers of lumefantrine and amodiaquine resistance
The Artesunate-Amodiaquine/Artemether Lumefantrine (AS-AQ/AL) Molecular Marker Study Group demonstrated that if patients are infected with malaria parasites that carry particular mutations in genes pfcrt and pfmdr1, they are at higher risk of treatment failure after artemether-lumefantrine (AL).
Related publications:
Venkatesan M, et al. Polymorphisms in Plasmodium falciparum Chloroquine Resistance Transporter and Multidrug Resistance 1 Genes: Parasite Risk Factors that Affect Treatment Outcomes for P. falciparum Malaria after Artemether-Lumefantrine and Artesunate-Amodiaquine.  Am J Trop Med Hyg. 2014 Oct;91(4):833-43. doi: 10.4269/ajtmh.14-0031. 

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