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Issue Date: February 2009, Posted On: 2/17/2009

Genzyme turns to India in fight against malaria

By Mark Connors
CAMBRIDGE, Mass. – Cambridge-based biotechnology giant Genzyme Corp. has teamed up with two area academic heavyweights and an Indian pharmaceutical company to develop new treatments for malaria.
The partnership has already begun screening several drug compounds. One important aim of the new initiative is to develop therapies to address the danger of emerging drug resistance that current anti-malaria treatments increasingly face.
The partnership also includes Medicines for Malaria Venture, a Switzerland-based nonprofit organization dedicated to the research and development of malaria treatments; The Broad Institute at the Massachusetts Institute of Technology and Harvard University, a collaboration between the two schools dedicated to the study of genomics and biomedical sciences; and Advinius Therapeutics, a Bangalore, India-based pharmaceutical research company.
“Malaria kills between 1 million and 2 million people annually, with the majority of victims being children under 5 years old and pregnant women,” said Chris Hentschel, president and chief executive officer of Medicines for Malaria Venture. “The pipeline of new molecules that are effective against malaria must be made more robust so that we can develop the next generation of powerful treatments.”
Ninety percent of malaria cases are reported in sub-Saharan Africa, but the disease appears to be growing in tropical areas of Asia and Latin America. The disease is considered a major contributor to poverty and a hindrance to economic development.
No vaccine is available for malaria and preventative drugs, though often effective, need to be taken continuously and are considered too expensive for people living in regions where the disease is most prevalent. Prevention methods tend to focus on controlling the mosquito population that spreads the disease.
India nearly eradicated malaria in the early 1960s, thanks to aggressive government-funded treatment and prevention programs. However the disease re-emerged in 1965 and continued to increase in prevalence, peaking in 1976 with 6.5 million cases reported. Although the prevalence of the disease has again retreated, it remains a major public health problem in India. More than 1 million cases of the disease were reported in the country in 2006.
“India today is one of the few countries in the world that has not only the disease burden, but also the capability to research and develop new therapies for [neglected] diseases,” Rashmi Barbhaiya, chief executive officer of Advinus, said in a statement. “Advinus, in particular … is uniquely positioned to work with MMV and Genzyme to address this crucial public health problem.”
Genzyme formally launched in India last year. The company said it does not intend to profit from treatments developed through the partnership. The company, founded in 1981, has more than 10,000 employees and reported revenues of $3.8 billion in 2007.
www.indusbusinessjournal.com/ME2/dirm...
=8F3A7027421841978F18BE895F87F791&tier=4&id=8A2A283C6F6942F5BC9033F410C8656A
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Launch of child malaria drug threatens local industry
Sunday, 22nd February, 2009

By Anthony Bugembe

THE launch of Coartem Dispersible, a child-friendly anti-malarial medicine, has been received with mixed feelings.

The medicine, launched in different African countries, is a product of Medicines for Malaria Venture (MMV), a Swiss non-profit company and Novartis, a multinational pharmaceutical.

Under the MMV/Novartis partnership, the medicine will be sold at $0.37 (about sh722) per treatment.
“This is the first pediatric malaria cure that is dispersible, sweet and has stringent regulatory approval,” the partnership announced.

Emmanuel Otaala, the outgoing primary health care state minister said: “The launch of the drug means enhancement of our efforts in the fight against malaria in children. It comes at a time when we are scaling up access to affordable and more effective anti-malaria drugs.”

Following resistance of malaria to drugs like chloroquine, the Government and the World Health Organisation (WHO) recommended a new class of anti-malarial medicines called Artemisinin Combination Therapies (ACTs).

“The only fear is that we have a factory manufacturing Anti-malarial drugs (Luzira-based Quality Chemicals),” Otaala said.

Dr. Ambrose Talisuna, the MMV country director, said if WHO approved Quality Chemicals and it started producing the medicine, then it would be up to the Government to buy from it or not.

“We want Ugandans to enjoy high quality medicine. At the moment, Uganda cannot use the Global Fund or WHO money to buy drugs from Quality Chemicals because the factory has not yet been pre-qualified by WHO,” Talisuna said.

Dr. Chris Hentschel, the MMV chief executive officer, said: “Getting babies to take bitter malaria medicines is difficult, but mothers in Africa can now easily give their children a sweet and effective cure, which will save their lives.”

A study published in The Lancet, a science journal, showed that Coartem Dispersible provided a high cure rate of 97.8%.

Malaria kills 320 people in Uganda every day. Most of these are pregnant women and children below five years.

Uganda is one of the first countries to benefit from the Affordable Medicines for Malaria Facility, which delivers subsidised medicines at an affordable price.
www.newvision.co.ug/D/8/13/672366
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Uit het jaarverslag 2008.

Malaria Vaccine based on AdVac®/PER.C6® Technologies:

Crucell and its collaborator, the US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), are conducting a Phase I trial in the U.S. The study is being carried out at two sites, Vanderbilt University in Nashville, Tennessee and Stanford University in Palo Alto, California. The first three cohorts have been enrolled and ongoing safety monitoring has revealed no significant safety concerns to date, but formal analysis awaits unblinding of the data. Enrollment for the fourth and final group of volunteers is ongoing. Preliminary results of the first three cohorts are expected before the end of the first quarter of 2009. Further updates on this program will be communicated in our first quarter 2009 results.

Deze of volgende week een update.

IMO

Dirk
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quote:

Dirk R. Wijnen schreef:

Uit het jaarverslag 2008.

Malaria Vaccine
...
Further updates on this program will be communicated in our first quarter 2009 results.

Deze of volgende week een update.
Dirk
Nog eventjes wachten tot 6 mei, Dirk:
investors.crucell.com/C/132631/event_...
Date Title
06 May 2009 Q1 Results 2009
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Joepie, straks de natuur in met een laserkanon afgericht op dazen en strontvliegen. En in de nazomer verdelgen we er wespen mee die de BBQ komen verstoren.

Drink ik morgen een Deutsche Eiswein op (uit de Aldi).
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finance.yahoo.com/news/Merck-amp-Co-I...

Merck & Co., Inc. Donates Antimalarial Candidate to Medicines for Malaria Venture for Use in Developing World
Wednesday March 18, 2009, 3:00 am EDT
Buzz up! Print Related:Merck & Co. Inc.
WHITEHOUSE STATION, N.J. & GENEVA--(BUSINESS WIRE)--Merck & Co., Inc. and Medicines for Malaria Venture (MMV), a not-for-profit virtual research and development organization dedicated to reducing the burden of malaria, today announced a licensing agreement for an investigational drug candidate for the treatment of malaria in the developing world.

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{"s" : "mrk","k" : "c10,l10,p20,t10","o" : "","j" : ""} Under terms of the agreement, Merck, whose researchers discovered the candidate, has granted MMV an exclusive, royalty-free license to pursue development of the investigational candidate for the treatment of malaria in malaria-endemic countries. Merck retains the option to become MMV's development partner upon completion of the first Phase II clinical trial of the candidate. Also within the agreement Merck has committed to not ultimately profiting from its use in developing countries.

"There remains a significant need for the development of novel drugs to treat and prevent life-threatening malaria infections due to the increasing emergence of resistance to current therapies. It is also important that these new drugs are cost-effective and curative after only a few days of therapy," said Dennis M. Schmatz, Ph.D., vice president Merck Research Laboratories. "By partnering with MMV on this project we hope to accelerate the clinical development of this promising candidate to hopefully meet these needs."

“Malaria researchers are working round the clock to develop new medicines to stem the unacceptable loss of life due to this deadly disease,” said Dr. Chris Hentschel, president and chief executive officer of MMV. "MMV welcomes this opportunity to work with Merck and to move research on this exciting antimalarial candidate into the development phase. The more treatments we can develop against the deadly malaria parasite the closer we will get to its ultimate eradication."

The antimalarial candidate is an orally available compound, which could potentially provide a daily or twice-daily curative dosing regimen. In preclinical studies, it has shown to be effective against P. falciparum, the organism that causes acute malaria, including multi-drug resistant strains. The compound is produced via relatively simple chemical synthesis and demonstrates a high degree of stability. For these reasons, it is anticipated that, if shown to be effective in treating malaria in humans, it should be possible to produce large quantities of the drug at low cost. Given the magnitude of the global malaria challenge, it is essential that effective drugs can be produced in sufficient quantities and at an affordable price to enable availability in the world's poorest countries.

Preclinical safety and efficacy evaluation of the antimalarial drug candidate has been completed, and it is now ready to be advanced to clinical studies evaluating its safety and efficacy in humans. MMV will be responsible for the clinical program at this stage and representatives from Merck will be included as members of the advisory board for the project.

About Medicines for Malaria Venture

Medicines for Malaria Venture (MMV) was established in 1999 as a not-for-profit organization created to discover, develop and deliver safe, effective and affordable antimalarial drugs through effective public-private partnerships. MMV’s vision is a world in which affordable and effective medicines will cure and protect the millions at risk of malaria and help to ultimately eradicate this terrible disease.

MMV is currently managing the largest–ever portfolio of antimalarial projects in collaboration with over 100 pharmaceutical, academic, and endemic-country partners in 38 countries. Its robust portfolio of around 50 projects includes 19 completely new classes of compounds in the discovery phase. In partnership with Novartis, MMV has recently launched its first product – Coartem Dispersible a unique, child-friendly, sweet-tasting, dispersible formulation of the parent drug Coartem®. The two remaining projects in clinical development will be registered by stringent regulatory authorities and are expected to gain market authorization by 2010.

About Merck

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit www.merck.com.

Forward-Looking Statement

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management's current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forward-looking statements may include statements regarding product development, product potential or financial performance. No forward-looking statement can be guaranteed and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the many uncertainties that affect Merck's business, particularly those mentioned in the risk factors and cautionary statements in Item 1A of Merck's Form 10-K for the year ended Dec. 31, 2008, and in any risk factors or cautionary statements contained in the Company's periodic reports on Form 10-Q or current reports on Form 8-K, which the Company incorporates by reference.

Contact:
Merck & Co., Inc.
Ian R. McConnell, 908-423-3046
or
MMV
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March 19, 2009

To the Editor: The results of the trial reported by Bejon et al. (Dec. 11 issue),1 in which the malaria vaccine RTS,S/AS01E was administered to children in Kilifi, Kenya, and Korogwe, Tanzania, are impressive. However, there are methodologic issues in the measurement of protective efficacy in sites where the transmission of malaria is falling. In such areas, transmission becomes overdispersed, and measuring protective efficacy against malaria over short periods may be inappropriate.2 For example, the high protective efficacy of intermittent preventive treatment for malaria in infants that was observed in the first clinical trial in Tanzania was probably exaggerated by a fall in transmission during the trial.3 Administration of the RTS,S vaccine in adults was shown to give short-lived protection,4 and in the study by Bejon et al.,1 the incidence of malaria was highest in the placebo group between 3 and 5 months after vaccination. This combination of decreasing transmission and protection over time could lead to an overestimate of efficacy
content.nejm.org/cgi/content/full/360...

Efficacy of RTS,S/AS01E Vaccine against Malaria
in Children 5 to 17 Months of Age
content.nejm.org/cgi/reprint/359/24/2...
www.iex.nl/Forum/topic.asp?forum=228&...
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March 19, 2009

To the Editor: The results of the trial reported by Bejon et al. (Dec. 11 issue),1 in which the malaria vaccine RTS,S/AS01E was administered to children in Kilifi, Kenya, and Korogwe, Tanzania, are impressive. However,...
The authors reply: In response to the comments by Gosling and Chandramohan: overdispersion in malaria is not necessarily limited to areas of falling transmission,1 and it also occurs in infectious diseases other than malaria.2 Our reading of the survival plots is of sustained transmission throughout the period of monitoring, although transmission has indeed been falling in the study areas.3,4 We certainly agree that estimates of efficacy during long-term follow-up are essential, and such estimates have been made for RTS,S/AS02A, with encouraging results.5 The data on vaccine efficacy for RTS,S are significantly more consistent and encouraging than the data available for SPf66 at any stage of its development. The comparison may not be informative. Nevertheless, we agree with Gosling and Chandramohan that point estimates of vaccine efficacy from phase 2b studies, such as the results we report, are surrounded by uncertainty. RTS,S/AS01E will be evaluated in a wide range of transmission sites and over longer periods of follow-up in a planned phase 3 multicenter efficacy trial.

Philip Bejon, Ph.D.
Kenya Medical Research Institute
Kilifi, Kenya
pbejon@kilifi.kemri-wellcome.org

Amanda Leach, M.R.C.P.C.H.
GlaxoSmithKline Biologicals
1330 Rixensart, Belgium

Lorenz von Seidlein, Ph.D.
International Vaccine Institute
Seoul 1S1-500, Korea
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Setback for GSK’s malaria vaccine
By Andrew Jack in London

Published: March 31 2009 00:14
GlaxoSmithKline faced a setback for its experimental malaria vaccine on Monday when the authorities in the first country due to host final-stage clinical trials called a temporary halt just before testing was to begin.
The UK pharmaceutical group was scheduled to begin the first vaccinations in small children for a large-scale phase-three trial for its product RTS,S, also branded Mosquirix, in Gabon at the start of this week but froze the trial when the national ministry of health requested further information.

Individuals working on the trial said they were trying to clarify what extra data were required, and hoped it would proceed rapidly.
The unexpected hold-up highlights the challenges of conducting ambitious clinical trials even in African countries that could most benefit from a successful malaria vaccine.
The clarification may relate to the appointment of a new minister of health in Gabon only at the start of this year who wants to be present at the vaccination but is currently travelling, as well as recent lack of communication because government offices were closed for a week after the death of the country’s first lady.
Mosquirix has shown strong results in earlier-stage trials and a positive result from the latest test should lead to a filing for regulatory approval – although that will still require the need to find substantial international donor funding to cover the costs of manufacture and distribution.
Meanwhile, GSK filed additional data with US regulators on Monday as it sought approval for Cervarix, its cervical cancer vaccine long approved in Europe and other markets.
The US Food and Drug Administration is believed to have requested more information linked to the vaccine’s proprietary adjuvant, a chemical mix that boosts the body’s immune response. A similar adjuvant is used in Mosquirix and other vaccines the company is developing.
Copyright The Financial Times Limited 2009

www.ft.com/cms/s/0/d5f05504-1d51-11de...
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Pfizer and Medicines for Malaria Venture Advancing International Research Efforts in the Fight against Malaria

NEW YORK & GENEVA--(BUSINESS WIRE)--Pfizer Inc and Medicines for Malaria Venture (MVV) have signed an agreement that is designed to facilitate advancements in the battle against malaria, a disease that afflicts vulnerable populations in the developing world each year. Under the agreement, MMV will have access to the Pfizer library of novel chemical entities, in order to screen it for compounds that have the potential to be developed into new treatments for malaria.

Malaria causes an estimated 881,000 deaths each year, of which over 90% are in Africa and 85% are children under 5 years of age.

“People are suffering in developing countries and we want to help by sharing resources and boosting research against tropical diseases,” said Dr. Rod MacKenzie, senior vice president of Research, Pfizer Global Research & Development. “Although this is early-stage research, which means that effective new treatments may only begin to be developed several years from now, it improves the chances of identifying compounds that may lead to new drugs. We believe public-private research collaborations are vital to tackling health challenges in developing countries, and we are confident our collaboration with MMV will further aid in the search for drugs with the potential to treat malaria.”

etc.

www.pfizer.com/news/press_releases/pf...
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Malaria
We are developing a recombinant malaria vaccine based on our AdVac technology and produced on our PER.C6
production technology. The vaccine is made by inserting the gene for the circumsporozoite protein (CSP) from a malaria
parasite into an adenoviral vector, which acts as a ‘vehicle’ for vaccination delivery.
The efficacy of our malaria vaccine candidate was tested in pre-clinical models. The study showed that a single
administration of a prototype AdVac vaccine, provided protection against the specific parasite. Since March 2004, we
have collaborated with the NIAID for the support of the development of our candidate malaria vaccine. In
September 2006, we extended our collaboration with the NIAID by signing a clinical trial agreement.
In partnership with the NIAID, Crucell’s malaria vaccine entered a phase I trial in the US in January 2007. The study is
being carried out on two sites, Vanderbilt University in Tennessee and Stanford University in California. The first three
groups have been enrolled and ongoing safety monitoring has revealed no significant safety concerns to date, but formal
analysis awaits unblinding of the data. Further updates on this program are expected in the second quarter of 2009.
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U.S. aims to be global leader in malaria fight
President wants to end deaths from mosquito-borne disease by 2015
The Associated Press
updated 8:41 p.m. ET April 23, 2009

WASHINGTON - President Barack Obama is committed to making the United States a global leader in ending the nearly 1 million deaths annually from malaria by 2015, the U.S. ambassador to the United Nations says.

The goal is shared by U.N. Secretary-General Ban Ki-moon and the African Union, according to excerpts from Susan Rice’s prepared speech to a malaria summit on Friday made available to The Associated Press.

“Malaria, simply put, is something we can end. And today I am here to say that malaria is a scourge we can end,” she said.

Rice is the keynote speaker at the summit on the eve of the second World Malaria Day that will bring together global leaders in the fight against malaria and African and American faith leaders. They will launch a campaign to mobilize resources to help interfaith institutions in Africa fight malaria more effectively through increased mosquito net distribution and local community education.

On the first World Malaria Day a year ago, the U.N. secretary-general announced a new global initiative to provide mosquito nets and insecticide spraying for everyone at risk of malaria, diagnosis and treatment for those with the disease, and training for community health workers to deal with malaria. He said the initiative would also encourage research into the control, elimination and eradication of malaria.

Ban said the aim of his “bold but achievable vision ... is to put a stop to malaria deaths by ensuring universal coverage by the end of 2010.”

The timetable that Rice gives is five years longer.

“President Obama is committed to making the United States a global leader in ending deaths from malaria by 2015,” she said. “If we continue to work in the spirit of unity and shared purpose that has already led to substantial progress, this is a target we can hit.”

The World Health Organization estimates that nearly 250 million people get malaria every year, and it kills almost 1 million, the vast majority young children. Many drugs have lost their effectiveness against the parasite, and there is no vaccine, although advanced testing of an experimental candidate that promises partial protection is under way.

Rice said there has been “significant progress, and we have the tools to do even more.”

“We now have effective and increasingly affordable drugs to treat malaria and related illnesses,” she said. “We now have reliable ways to prevent malaria, especially bed nets treated with insecticides, indoor spraying, and safe, inexpensive drugs that can be provided to pregnant women.”

But eliminating malaria deaths won’t be easy, she said.

“For about half the world’s population, malaria is still one of the greatest threats to public health — a disease that plunges families into poverty, rattles already shaky public health systems, and steals Africa’s children away from her,” Rice said.

Every day, nearly 3,000 people died of malaria, nearly 90 percent of them children under the age of 5, she said, adding: “That is a human cost that we will never be able to fully tally.”
© 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

URL: www.msnbc.msn.com/id/30377157/
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The Lancet, Volume 373, Issue 9673, Pages 1409 - 1411, 25 April 2009

doi:10.1016/S0140-6736(09)60801-1
Malaria: 2 years in the fast lane
Richard GA Feachem a , Allison A Phillips a
World Malaria Day (April 25) is upon us once again. Over the past 2 years, the world has made remarkable advances in malaria. 2 years ago, nobody was mentioning elimination and eradication. Then, on Oct 17, 2007, Bill and Melinda Gates made their famous speech in Seattle, USA, calling for global eradication.1 1 year ago, there was no consensus on how we would achieve a malaria-free world. Currently, a Global Malaria Action Plan2 has been developed under the leadership of Roll Back Malaria, which set out a three-part strategy. First, aggressive control in the malaria heartland to achieve low transmission and mortality in those 61 tropical countries with the highest burden of disease. Second, progressive elimination from the endemic margins inward to shrink the malaria map. Third, research to find a vaccine and better drugs, diagnostics, insecticides, and other tools.
For the first part of the strategy, we have witnessed a massive scale-up in antimalaria programmes in the malaria heartland. Global Fund round 7 approved a total of US$1031 million for malaria and round 8 a further staggering $2911 million.3 The US President's Malaria Initiative4 and the World Bank's Booster Programme5 have continued to scale up operations in the malaria heartland. These investments are producing substantial reductions in malaria in countries such as Brazil, India, and Zambia.6 Furthermore, the private sector is increasing its investment to control malaria in countries such as Angola,7 Ghana, and Nigeria.
2 years ago, countries pursuing the second part of the strategy received little support. Elimination is now an active field, from policy to implementation. At present, 39 countries (over a third of all malaria-endemic countries) have set ambitious, yet attainable, goals for freeing their country from malaria in the foreseeable future. Among these countries, various regional malaria-elimination collaborations have been established, including the E8 (Elimination 8) in southern Africa and the Asia Pacific Malaria Elimination Network.8
The Malaria Elimination Group (MEG) was convened by the Global Health Group at the University of California (San Francisco) to support countries that are pursuing or considering elimination. MEG recently published two documents on elimination.9, 10 These documents will assist policy makers, investors, and implementers as they make decisions related to the second part of the strategy.
For the third part of the strategy, malaria research—including drugs, vaccines, and diagnostics—has continued to flourish. The Malaria Eradication Research Agenda (MalERA)11 has been recently launched and is developing a comprehensive research agenda to ensure that we have the technologies to free the planet of malaria.
Additionally, there has been a remarkable surge of non-governmental organisations and civil-society activity in malaria. Several organisations against malaria have sprung into existence. Malaria No More12 has already raised over $37 million, and aims to create a $100 million malaria fund.
Finally, on the political stage, we see the appointment of Ray Chambers as the UN Secretary-General's special envoy on malaria. Also, the USA has followed the UK in creating a bipartisan and bicameral malaria parliamentary group, known as the Congressional Malaria Caucus.13
Where does all this leave us? The political commitment could hardly be stronger. Big sums of money are now flowing, but whether these sums will survive the recession is debatable. Encouragingly, some wealthy countries have pledged not to let the recession reduce their financial commitments for health and development.14 The challenge now is the implementation gap between political commitment, ambition, and availability of funds, and the capacity at ground level to do the work that needs to be done. Strong management, effective coordination among all partners in the public and private sectors, a culture of accountability for performance and outcomes, and long-term commitment by financial institutions are all imperative.
Overall, we have many reasons to be optimistic. Except for those countries that are politically dysfunctional or suffering major conflicts, the 61 malaria-control countries in the heartland will make great progress in reducing death and sickness from malaria over the next 10 years. Meanwhile, many of the 39 malaria-elimination countries will successfully get rid of malaria, and the malaria map will be substantially shrunk. Also, if the pace of malaria research continues, we can expect a first vaccine, important therapeutic advances, and further progress in the development of sensitive and specific point-of-treatment diagnostic tests.15 All this will move us forward towards a malaria-free world in the middle of the 21st century.
RGAF directs the Global Health Group at the University of California partly devoted to malaria elimination and funded by the Bill & Melinda Gates Foundation and ExxonMobil. RGAF serves on the board of Malaria No More and was formerly the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. AAP manages the Malaria Elimination Initiative at the Global Health Group. We thank Chris Cotter and Cara Smith-Gueye of the Global Health Group for helpful suggestions and research support.
www.thelancet.com/journals/lancet/art...
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World Malaria Day (April 25) is a time to assess key achievements and future goals in malaria control and elimination. In a Comment, Sir Richard Feachem and Allison Phillips discuss the rapid progress made in malaria control and elimination in the past two years, and discuss their optimism for the future. A second Comment outlines in detail the progress towards a malaria vaccine. Listen to Pam Das introducing a special World Malaria Day podcast.
podcast.thelancet.com/audio/lancet/20...
www.thelancet.com/
_________________
The Lancet, Volume 373, Issue 9673, Pages 1411 - 1412, 25 April 2009
<
doi:10.1016/S0140-6736(09)60802-3
Vasee Moorthy a b , Peter G Smith c, Marie-Paule Kieny a
A vaccine against malaria: a substantial step forward

Two recent studies by Philip Bejon1 and Salim Abdulla,2 and their respective colleagues, represent an important step towards the development of a malaria vaccine that shows great promise for being deployable in malaria-control programmes.
Bejon and colleagues did a phase II trial in over 800 children aged 5—17 months in Kenya and Tanzania. The researchers aimed to evaluate the efficacy against clinical malaria of the most advanced candidate for a Plasmodium falciparum vaccine, RTS,S/AS01. The control group received rabies vaccine. The efficacy against all clinical episodes of malaria was 56% (95% CI 31—72%), after an average of 8 months' follow-up after the third vaccine dose. This efficacy is higher than the 27% (6—44%) in an earlier study in Mozambique in children aged 1—4 years with the same vaccine antigen but a different adjuvant (AS02A).3 Although the confidence intervals for these estimates overlap, the AS01 adjuvant is more immunogenic, which is plausibly associated with higher efficacy. Compared with the AS02A adjuvant vaccine, use of AS01 has induced a stronger IgG response to the immunodominant B-cell epitope, together with improved cell-mediated immune responses in adults in non-endemic settings. However, a direct immunological correlate of protection against clinical malaria remains elusive, and Bejon found no association between the levels of circumsporozoite antibodies induced by the vaccine and protection against clinical disease.
Abdulla and colleagues' trial in 340 infants was designed to assess whether the malaria vaccine, given with a different adjuvant AS02, was safe when administered at the same time as vaccines currently in use in the expanded programme on immunisation (EPI), and whether the co-administration interfered with immune responses to the other vaccines. Infants received RTS,S/AS02 or hepatitis B vaccine co-administered with diphtheria and tetanus toxoid, whole-cell pertussis, and conjugated Haemophilus influenzae type b vaccines. There were no important safety concerns associated with the malaria vaccine and there was no significant reduction in the proportions of infants seroconverting to the EPI vaccines, although there were reductions in the immune responses for all of the co-administered vaccines except hepatitis B. RTS,S/AS01 includes an adjuvant that is not administered with any currently licensed vaccines. Although there have been no safety concerns to date, a key objective of a phase III trial will be to provide further data on vaccine safety.
It will be important to follow up the population in Bejon and colleagues' trial for evidence of lasting protection. Concerns about the possible short duration of protection in the Mozambique trial of RTS,S after 6 months of follow-up,4 as had been observed in an earlier trial of the RTS,S vaccine in adults,5 proved unfounded, and the extended follow-up in the Mozambique trial showed protection at around 30%, which persisted until at least 21 months after vaccination.6 In the Mozambique trial, although it was not a primary endpoint, there was suggestive evidence that the protection against severe malaria was greater than against clinical malaria (49% vs 29%, respectively). The number of cases of severe malaria in Bejon's trial was small, but it is encouraging that only one of the nine cases was in the vaccinated group. In the planned phase III trial, it would be highly desirable to power the trial to include severe malaria disease as a key endpoint.
The story of RTS,S is illuminating, particularly in what it has to tell the malaria-vaccine field about the crucial importance of robust evaluation technologies. The experience with RTS,S provides a resounding confirmation of the usefulness of the clinical sporozoite challenge model,7 the importance of dual induction of long-lived potent IgG-mediated and cell-mediated immune responses for protection with circumsporozoite antigen-based vaccines, and the role of adjuvant formulations and virus-like particles in generating protective immune responses. Success with RTS,S vaccine science is driving commitments to research and development of a second-generation vaccine with a target efficacy in excess of 80%, as outlined as a goal for 2025 in the strategic framework of the Malaria Vaccine Technology Roadmap, which has been endorsed by a group of major malaria-vaccine stakeholders.8 To allow rational selection of the new second-generation candidates, further work is necessary to reduce variability in both preclinical and clinical immunoassays and functional assays, and to strengthen clinical challenge models.
Areas of controversy remain in the design and analysis of malaria-vaccine trials, including whether primary attention should be focused on any delay in the first episode of malaria after vaccination, whether any second or subsequent episodes should be evaluated, or whether a better measure of effect might be in the proportion of children who have had no attack of malaria by some defined time after vaccination.9 These and related issues have been the subject of recent WHO consultations.10, 11
Further challenges for malaria-vaccine developers include: generation of appropriate information to facilitate registration of such a product for use only in malaria-endemic countries; setting up appropriate postmarketing safety surveillance in populations with few established adverse-event reporting systems for vaccines; and finding finance for use of a malaria vaccine in health systems with many competing demands, including from other new vaccines.
The impressive progress that has been made with the RTS,S development programme over the past 10 years raises the prospect of a P falciparum vaccine that will be assessed for implementation in endemic countries, and provides every reason to believe that, in the longer term, further progress can be made towards development of a highly efficacious second-generation vaccine, if funding and commitment are provided.
VM and PGS have received travel and accommodation costs as advisers to the Malaria Vaccine Initiative, and are co-authors on 10, 11 which are meeting reports. M-PK declares that she has no conflicts of interest. We are responsible for the views in this Comment, which do not necessarily represent the decisions or the stated policy of WHO.
www.thelancet.com/journals/lancet/art...
flosz
0
World Malaria Day
Each April 25, hundreds of organizations come together in the fight against malaria, joining forces to combat the disease.
Learn more about malaria—what it is, how it is transmitted, and what’s being done to save lives.
www.gatesfoundation.org/malaria/Pages...

Can We Really Eradicate Malaria?See how the development of new medicines and vaccines and the increased use of bed nets and indoor spraying are making a difference.
www.gatesfoundation.org/topics/Pages/...

“Why I Work to Stop Malaria”As a young girl in Ghana, Dr. Ofori-Anyinam watched her family get sick from malaria. Today, she is working to develop a vaccine.
www.gatesfoundation.org/topics/Pages/...

Bill Gates: Progress in Global HealthIn this audio slideshow, learn why continued investments in global health are critical.
www.gatesfoundation.org/annual-letter...
Alpen
0
Glaxo to start final-stage malaria vaccine trial

* Phase III study of Glaxo's Mosquirix to start in weeks
* Vaccine to be submitted for approval in 2011
* Trial to enrol 16,000 children in seven African countries
* Preferential pricing to ensure access in Africa

GENEVA/LONDON, April 24 (Reuters) - GlaxoSmithKline Plc (GSK.L) is about to start final-stage clinical trials of the world's most advanced malaria vaccine, which could reach the market within three years, the drugmaker said on Friday.

If successful, Glaxo believes its Mosquirix vaccine has the potential to save hundreds of thousands of deaths and prevent tens of millions of cases of malaria in Africa.

In what will be the largest medical experiment ever conducted in Africa, some 16,000 children and infants will be involved at 11 trial sites in seven countries.

Malaria kills around one million people a year -- most of them young children in sub-Saharan Africa.

Glaxo's vaccine is far from perfect but it is the best yet against the mosquito-borne parasite. Earlier clinical tests suggest it is 50-55 percent effective in preventing episodes of clinical malaria.

The Malaria Vaccine Initiative, which is working with Glaxo and the Bill & Melinda Gates Foundation on the project, has set a target of getting a vaccine that is at least 50 percent effective by 2015 and one that is 80 percent effective by 2025.

"Today that dream of a malaria vaccine is just about to become a reality in a few more years," Glaxo researcher Joe Cohen, who has worked on the project for over 20 years, told reporters.

"The pivotal Phase III registration trial will be starting within a few weeks."

Glaxo plans to file the vaccine for regulatory approval in 2011, under a special review procedure established by the European Medicines Agency for products designed for use in the developing world. Based on normal timelines that could see Mosquirix reaching the market in 2012.

The world's second largest drugmaker has invested more than $300 million in the vaccine to date and expects to invest at least another $100 million.

But Mosquirix is never likely to be a money-spinner.

With its target market in Africa, Glaxo will be selling the vaccine at preferential prices to international groups like the Global Alliance for Vaccines and Immunization.

"We cannot lose money but we don't need to make money on this," Jean Stephenne, head of Glaxo's vaccines unit, told Reuters recently.

Malaria has proved hard for vaccine developers to beat because the parasite that causes the disease has a complex life-cycle, inside mosquitoes and humans, which helps it evade the immune system.

The tiny parasites get into the blood and reproduce in the body, causing fever and sometimes deadly brain infections.

Mosquirix -- also known as RTS,S -- works by fusing part of a protein from the parasite to the surface of a hepatitis-B viral particle, stimulating the body's immune response. This hobbles the parasite's ability to infect and develop in the liver, giving partial protection against the disease. (Editing by Andrew Callus and Dan Lalor)

www.reuters.com/article/rbssHealthcar...
flosz
1
quote:

maxen schreef:

Chronologisch overzicht van Crucells Malaria trial - zoek de verschillen!

Bonus: Gedachte over Crucell's laatste cryptische mededeling betreffende deze trial.

December 19, 2006:
[quote=Crucell]
Crucell today announced that it has obtained regulatory and ethical approval to test the safety, tolerability and immunogenicity of its AdVac®-based malaria vaccine it is currently developing in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH). This opens the way for the imminent commencement of a Phase I clinical trial, with recruitment of volunteers underway.
The clinical trial will be a randomized, double-blind, placebo-controlled study that will test the vaccine in a dose-escalation trial involving 96 healthy volunteers. The Phase I trial will be funded by NIAID and conducted by researchers at Vanderbilt University, one of NIAID's Vaccine and Treatment Evaluation Units.
[/quote]
Q4 2006 (february 13, 2007):
[quote=Crucell]
Crucell obtained regulatory approval to start Phase I clinical trials to test safety, tolerability and immunogenicity of its malaria vaccine, developed in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH).
[/quote]
Q1 2007:
[quote=Crucell]
Crucell received a €2.4 million European Union-funded grant in January aimed at advancing the development of a malaria vaccine.
[/quote]
Q2 2007:
[quote=Crucell]
Crucell and its partner, the National Institute of Health (NIH), have decided to add clinical sites in the US to speed up recruitment for their Phase I trial. Phase I results are not expected to be available by year-end 2007.
[/quote]
Q3 2007:
[quote=Crucell]
Crucell and its partner, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), have added an additional clinical site in the US to speed up recruitment for their Phase I trial. Since opening the additional site, the pace of recruitment has increased allowing so far enrolment of 18 and 15 volunteers in the first and second cohort, respectively. Initial findings of Phase I results are expected to be available in 2008. No serious adverse side-effects have been reported to date.
[/quote]
Q4 2007 (12-02-2008):
[quote=Crucell]
AdVac®/PER.C6® Technology-Based Malaria Vaccine: Crucell and its partner, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), are conducting a Phase I trial in the U.S. The study is being carried out on two sites, VanderBilt and Stanford University. The first and second cohorts, comprising 18 and 17 volunteers respectively, have been successfully enrolled. No serious adverse side-effects have been reported to date. Current plans call for subsequent enrollment of two additional cohorts at higher vaccine doses, provided the vaccine has an appropriate safety profile. Following review of the safety data by a Safety Monitoring Committee, a decision has been made to begin recruitment of the third cohort. Initial findings of this Phase I trial are expected to be available in 2008.
[/quote]
Q1 2008:
[quote=Crucell]
The first and second cohorts, comprising of 18 and 17 volunteers respectively, have been enrolled. Enrollment of a third group of 18 volunteers is progressing and is near completion. Enrollment for the fourth and final group of volunteers is expected to start in the summer. Initial findings of this Phase I trial are expected to be available in 2008.
[/quote]
Q2 2008:
[quote=Crucell]
The first three cohorts, comprising of 18, 17 and 18 volunteers respectively, have been enrolled. Enrollment for the fourth and final group of volunteers is expected to start soon. Initial findings of this Phase I trial are expected to be available in 2008.
[/quote]

Q3 2008:
[quote=Crucell]
The first three cohorts have been enrolled and ongoing safety monitoring has revealed no significant safety concerns to date, but formal analysis awaits unblinding of the data. Enrollment for the fourth and final group of volunteers is still ongoing and initial findings of this Phase I trial are expected in the first quarter of 2009.
[/quote]
Q4 2008 (februari 2009):
[quote=Crucell]
The first three cohorts have been enrolled and ongoing safety monitoring has revealed no significant safety concerns to date, but formal analysis awaits unblinding of the data. Enrollment for the fourth and final group of volunteers is ongoing. Preliminary results of the first three cohorts are expected before the end of the first quarter of 2009. Further updates on this program will be communicated in our first quarter 2009 results.
[/quote]

Dus we zijn al meer dan twee jaartjes bezig, en het wordt wel minstens drie jaar voordat het is afgerond. ALS ie wordt afgerond, want wat betekent "further updates on this program will be communicated in Q109 results?"
Klinkt onheilspellend. Zou dat kunnen betekenen iets als:
"Ondanks dat we deze Ad5 malaria Phase I trial al meer dan twee jaar hebben laten voortkabbelen, hebben we met (langzaam) voortschrijdend inzicht, besloten om geheel van Ad5 vectoren af te stappen, en na onze HIV, Tuberculosis en Ebola/marburg vaccins, ook ons Malaria vaccin met andere, minder voorkomende Ad-vectoren te gaan maken, teneinde de problemen met bestaande immuniteit tegen Ad5 te voorkomen. We achtten het beter om NU nog te veranderen van vector, in plaats van afronding van de phase II trial in 2017. Praktisch betekent dit dat we een geheel nieuwe phase I trial op basis van rAdxx opstarten, die hopenlijk sneller zal gaan verlopen." Op lange termijn zien wij nog steeds een trivalent HIV/Tuberculosis/Malaria vaccin, en daarom zal de rAdxx vector qua immuniteit niet interfereren met de Ad35 vector voor ons Tuberculosis vaccin en de rAd26 vector voor ons HIV vaccin, en zelfs niet met de toekomstige rAdyy vector voor ons nieuwe Ebola/Marburg vaccin."
??
We zullen zien bij de Q1 2009 cijfers.
Aanvulling van maxen erbij:
maxen - 6 mei 09, 10:02
Crucell, Q109 schreef:

Malaria Vaccine based on AdVac®/PER.C6® Technologies: Crucell and its collaborator, the US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), are conducting a Phase I trial in the USA. The study is being carried out at two sites, Vanderbilt University in Nashville, Tennessee and Stanford University in Palo Alto, California. The first three cohorts have been enrolled and ongoing safety monitoring has revealed no significant safety concerns to date. Enrollment for the fourth and final group of volunteers is underway. Preliminary examination of the blinded data from the first three cohorts indicates the vaccine is immunogenic. Detailed analysis of the data awaits completion of the fourth cohort and unblinding of the data.

Toch wel weer zeer minieme verschillen. De malaria trial blijft op schema om Crucells langste phase I trial ooit te worden.

Dit zou dan de beloofde update moeten zijn: "Preliminary examination of the blinded data from the first three cohorts indicates the vaccine is immunogenic." Dat is dan op zich natuurlijk wel mooi, maar van een beloofde "update" verwacht je wat meer dan 1 zin.
www.iex.nl/forum/topic.asp?forum=228&...
flosz
0
Last Updated: April 30, 2009
Estimated Study Completion Date: October 2013
Estimated Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
clinicaltrials.gov/ct2/show/NCT00371189
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