Studies Confirm Antimalarial Drugs Remain Effective Across Multiple Regions and Patient Populations
Multiple studies confirm high effectiveness of key antimalarial drugs in Indonesia, Ethiopia, and for malaria prevention in HIV-positive pregnancies. Research shows DHA-PPQ, artemether-lumefantrine, and other treatments remain well-tolerated with no delayed parasite clearance. Findings support continued use of current treatment policies while emphasizing the need for ongoing monitoring.
Recent studies conducted in Indonesia, Ethiopia, and among HIV-positive pregnancies confirm that key antimalarial drugs remain highly effective for treating and preventing malaria, supporting their continued use in public health strategies. A large-scale therapeutic efficacy study in Papua, Indonesia, found that the country's first- and second-line malaria medicines continue to work well, while separate research in Northeast Ethiopia and a global meta-analysis provide further evidence on drug performance and safety.
From August 2024 to October 2025, researchers in Indonesia examined more than 700 malaria patients in Keerom and Kepulauan Yapen districts. The study assessed three medicines: dihydroartemisinin-piperaquine (DHA-PPQ), artesunate-pyronaridine (ASPY), and artemether-lumefantrine (AL). Findings showed no delayed parasite clearance and no serious adverse events. All three medicines maintained high effectiveness, with only a small number of patients experiencing persisting symptoms. This provides strong local evidence to confirm the continued use of DHA-PPQ as Indonesia's first-line treatment and guides the selection of effective second-line options.
In Northeast Ethiopia, a prospective observational study conducted from November 2024 to January 2026 assessed therapeutic efficacy, safety, and gametocyte clearance in 159 patients with uncomplicated malaria. Patients received artemether-lumefantrine for Plasmodium falciparum and chloroquine for Plasmodium vivax, with a subset also receiving a single low dose of primaquine. Therapeutic efficacy was high, with adequate clinical and parasitological response rates of 88.9% for P. falciparum and 97.4% for P. vivax. Fever and asexual parasite clearance occurred more rapidly in P. vivax than in P. falciparum. Primaquine significantly accelerated gametocyte clearance, reducing the median clearance time from 11 to 7 days in P. falciparum and from 7 to 4 days in P. vivax.
A separate systematic review and meta-analysis focused on malaria prevention in HIV-positive pregnancies. It evaluated the addition of DHA-PPQ to trimethoprim-sulfamethoxazole (TMP-SMX) for intermittent preventive treatment. Analyzing three studies with 1,353 participants, the review found that DHA-PPQ significantly lowered maternal adverse events, particularly gastrointestinal events and low hemoglobin. The addition showed a non-significant trend toward lower malaria infection outcomes, such as maternal parasitaemia and placental malaria. No significant differences were observed in fetal adverse events or birth outcomes, including low birth weight and premature birth.
These studies underscore the importance of continuous monitoring to track drug resistance and ensure effective case management. While the medicines remain effective, researchers emphasize that post-treatment gametocyte persistence may contribute to ongoing transmission, particularly in P. falciparum infections. The addition of low-dose primaquine enhanced gametocyte clearance in both malaria species in Ethiopia, highlighting its potential role in reducing transmission. Continued sentinel site monitoring and laboratory capacity strengthening remain essential to detect early signs of emerging resistance and adapt treatment policies accordingly.