Dihydroartemisinin-piperaquine: if it works for control, can we use it for elimination?

The artemisinin-derived combination dihydroartemisinin-piperaquine (DP), registered under the European Medicines Agency in 2011,2 would appear as an ideal candidate for the treatment of malaria, not only because of its high-demonstrated efficacy, but on account of its excellent tolerability and good safety profile, well reported in the literature.3-5 From a preventive point of view, the long half-life of the partner drug piperaquine conveys protection of 22 days for adult patients and around 20 days for paediatric patients,2 indicating a better post-treatment prophylactic effect than other combination therapies.3,6,7 In the Lancet Infectious Diseases, Julie Gutman and colleagues analyse the safety, tolerability, and efficacy of repeated doses of DP, for the treatment and prevention of malaria, with a particular focus on its use as intermittent preventive treatment (IPT).8 Their meta-analysis, looking at over 4000 patients exposed to repeated courses of DP, substantiates the high efficacy of this drug in terms of controlling malaria and all-cause hospital admission, and the good tolerability of repeated treatment schemes, with no evidence of arrhythmias secondary to the potential QT prolongation effect of cumulative doses of piperaquine after repeated doses.