Artemether-lumefantrine to treat malaria in pregnancy is associated with reduced placental haemozoin deposition compared to quinine in a randomized controlled trial.

Malaria Journal
Atis MuehlenbachsPatrice Piola

Abstract

Data on efficacy of artemisinin-based combination therapy (ACT) to treat Plasmodium falciparum during pregnancy in sub-Saharan Africa is scarce. A recent open label, randomized controlled trial in Mbarara, Uganda demonstrated that artemether-lumefantrine (AL) is not inferior to quinine to treat uncomplicated malaria in pregnancy. Haemozoin can persist in the placenta following clearance of parasites, however there is no data whether ACT can influence the amount of haemozoin or the dynamics of haemozoin clearance. Women attending antenatal clinics with weekly screening and positive blood smears by microscopy were eligible to participate in the trial and were followed to delivery. Placental haemozoin deposition and inflammation were assessed by histology. To determine whether AL was associated with increased haemozoin clearance, population haemozoin clearance curves were calculated based on the longitudinal data. Of 152 women enrolled in each arm, there were 97 and 98 placental biopsies obtained in the AL and quinine arms, respectively. AL was associated with decreased rates of moderate to high grade haemozoin deposition (13.3% versus 25.8%), which remained significant after correcting for gravidity, time of infection, re-infecti...Continue Reading

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Citations

Aug 12, 2014·Expert Opinion on Pharmacotherapy·Benjamin J VisserMartin P Grobusch
May 27, 2016·The Journal of Infectious Diseases·Atis MuehlenbachsSherif R Zaki
Dec 4, 2012·Expert Review of Anti-infective Therapy·Michal FriedPatrick E Duffy
Feb 6, 2018·The Lancet Infectious Diseases·Umberto D'AlessandroEsperanca Sevene

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Methods Mentioned

BETA
PCR
biopsies
genotyping

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SAS
Statview
Excel
CONSORT

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