Nick White and colleagues have recently published in New England Journal Of Medicine the results of a Phase 2 open-label study of the new spiroindolone KAE609 (cipargamin). This is a new class of anti-malarials developed at the Novartis Institute for Tropical Diseases in Singapore. The compound is not an endo-peroxide, but the results seem to show that it is as effective as the artemisinins in treating both P falciparum and P vivax infections in humans. The study is small, only 10 patients with vivax and 11 with falciparum malaria were treated. However, these results indicate that KAE609 may act more quickly than artemisinins – the speed of action of the endo-peroxides being one of their most important attributes – and (very importantly) is also active against artemisinin-resistant strains of P falciparum. If this is confirmed by further clinical studies, it could mean that KAE609 (or other drugs in the same class) could arrive just in time to replace artemisinins, as resistance spreads from its Cambodian epicentre.
The paper can be found on the NEJM website: PAPER