ASAQ

Short-course fixed-dose combination for easier administration

Affordable, fixed-dose drug combination simplifies malaria treatment

With older antimalarial medicines increasingly ineffective due to growing drug resistance, in 2001 WHO recommended the use of artemisinin-based combination therapies as first-line malaria treatment.

However, there were no combinations of the recommended drugs. This meant that people had to take each drug in separate tablets – complicating administration and increasing the likelihood of drug resistance developing due to people not taking the full and correct dose of both medicines.

The dispersible, fixed-dose combination of artesunate and amodiaquine (ASAQ) requires only one dose per day for three days, reducing the “pill burden” for both adults and children. It is also easier to administer to infants and young children because it dissolves in water. A dual-aluminium blister packaging ensures a three-year shelf-life, even in a tropical environment.

ASAQ was developed as a public good, so it is affordable and has no patents, making it available for production by any generic drug manufacturer that meets quality standards.

• Indication: Malaria
• Dosage: Single daily fixed-dose combination of artesunate & amodiaquine for 3 days

Impact

• Registered in 35 countries and territories since 2007
• More than 540 million treatments distributed since 2007
• First registered in Morocco to enable rapid exportation to other African countries
• No patent: Developed as a public good, so any generic company meeting quality standards can produce it
• Technology transfer to Zenufa (Tanzania)
• Five different manufacturers’ ASAQ products are now prequalified by WHO
• Handed over to Medicines for Malaria Venture access team in 2015 for continued implementation
• Released at a cost of only US $0.50 for children, US $1.00 for adults

History – the FACT project

In response to WHO’s recommendation of artesunate combination therapies to treat malaria, Médecins Sans Frontières, the WHO Special Programme for Research and Training in Tropical Diseases, and other partners established the Fixed-Dose-Artesunate Combination Therapy (FACT) project in 2002. When DNDi was created in 2003, it took over management of the FACT project.

FACT’s objective was to develop two fixed-dose combination therapies containing artemisinin for the treatment of malaria. The urgency of these goals was confirmed by WHO’s 2006 malaria treatment guidelines calling for an immediate halt to artemisinin monotherapy, to prevent the creation of drug resistance. ASAQ was first released in 2007.