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Review
. 2021 Dec 22:17:1353-1370.
doi: 10.2147/TCRM.S336771. eCollection 2021.

Efficacy and Safety of Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria in Pregnant Women: A Systematic Review and Meta-Analysis

Workineh Shibeshi  1 , Assefa Mulu Baye  1 , Getachew Alemkere  1 , Ephrem Engidawork  1
Affiliations
Review

Efficacy and Safety of Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria in Pregnant Women: A Systematic Review and Meta-Analysis

Workineh Shibeshi et al. Ther Clin Risk Manag. .

Abstract

Introduction: Malaria is one of the infectious diseases with substantial risks for pregnant women, the fetus and the newborn child. Thus, prevention and treatment of malaria with safe and effective drugs is of paramount importance. Pregnant women are mostly excluded from clinical trials, and systematic approaches of pharmacovigilance in pregnancy are limited. This means the safety and efficacy of antimalarial agents during pregnancy are unclear.

Purpose: This study was designed to carry out a systematic review and aggregate data meta-analysis of literature published on efficacy and safety of artemisinin-based combination therapy (ACT) for uncomplicated malaria in pregnant women.

Methods: A search of literature published between 1998 to 2020 on efficacy and safety of artemisinin-based combination therapy (ACT) in pregnant women was made using Cochrane Library, Medline and the Malaria in Pregnancy Consortium Library. Data were extracted independently by two reviewers, and any discrepancies were resolved by consensus. Meta-analysis was carried out using Open Meta-Analyst software. Random effects model was applied, and the heterogeneity of studies was evaluated using Higgins I2.

Results: Twenty-four studies that fulfilled the inclusion criteria were included in the final assessment. Overall, days 28 to 63 malaria treatment success rate was 96.1%. Overall days 28 to 63 cure rates for AL, AS+AQ, AS+MQ, DHA+PQ, AS+ATQ+PG and AS+SP were 95.1%, 92.2%, 97.0%,94.3%, 96.5% and 97.4%, respectively. Comparison of ACTs with non-ACTs revealed that the risk of treatment failure was substantially lower in patients treated with ACTs than with non-ACTs (risk ratio 0.20, 95% C.I. 0.09-0.43). The overall prevalences of miscarriage, stillbirth and congenital anomalies were 0.3%, 2.1% and 1.0%, respectively, and found to be comparable among various ACTs. There was comparable tolerability across ACTs during pregnancy.

Conclusion: ACTs demonstrated a high cure rate, safety and tolerability against Plasmodium falciparum infection in pregnant women. The higher treatment success and comparable tolerability could be used as an input for decision makers to support the continued usage of ACTs for treatment of uncomplicated falciparum malaria in pregnant women.

Keywords: artemisinin-based combination therapy; efficacy; pregnant women; safety; systematic review and meta-analysis; uncomplicated malaria.

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Conflict of interest statement

The authors declare that there is not any real or perceived conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for search results February 28, 2020.
Figure 2
Figure 2
Efficacy of ACTs for the treatment of uncomplicated malaria in pregnant women.
Figure 3
Figure 3
Comparison of days 28 to 63 cure rate or ACPR among artemisinin combination therapy and non-artemisinin therapies in pregnant women.
See this image and copyright information in PMC

References

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