A systematic review of the safety and efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria during pregnancy

Malaria Journal

Review

Henrietta U Okafor¹  Umberto D’Alessandro²  Elizabeth Juma³  Kassoum Kayentao⁴  Kamal Hamed⁵  Christine Manyando⁶ 

[1] Department of Paediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria;Institute of Tropical Medicine, Antwerp, Belgium;Medical Research Council Unit, Fajara, The Gambia;Kenya Medical Research Institute, Kisumu, Kenya;Malaria Research and Training Centre, Bamako, Mali;Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA;Tropical Diseases Research Centre, Ndola, Zambia;

关键词: Artemether-lumefantrine;    Artemisinin-based combination therapy (ACT);    Pregnancy;    Malaria;    Plasmodium falciparum;   

DOI  :  10.1186/1475-2875-11-141

 received in 2011-12-22, accepted in 2012-05-01,  发布年份 2012

来源: Springer

【 摘 要 】

Malaria during pregnancy, particularly Plasmodium falciparum malaria, has been linked to increased morbidity and mortality, which must be reduced by both preventive measures and effective case management. The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) to treat uncomplicated falciparum malaria during the second and third trimesters of pregnancy, and quinine plus clindamycin during the first trimester. However, the national policies of many African countries currently recommend quinine throughout pregnancy. Therefore, the aim of this article is to provide a summary of the available data on the safety and efficacy of artemether-lumefantrine (AL) in pregnancy. An English-language search identified 16 publications from 1989 to October 2011 with reports of artemether or AL exposure in pregnancy, including randomized clinical trials, observational studies and systematic reviews. Overall, there were 1,103 reports of AL use in pregnant women: 890 second/third trimester exposures; 212 first trimester exposures; and one case where the trimester of exposure was not reported. In the second and third trimesters, AL was not associated with increased adverse pregnancy outcomes as compared with quinine or sulphadoxine-pyrimethamine, showed improved tolerability relative to quinine, and its efficacy was non-inferior to quinine. There is evidence to suggest that the pharmacokinetics of anti-malarial drugs may change in pregnancy, although the impact on efficacy and safety needs to be studied further, especially since the majority of studies report high cure rates and adequate tolerability. As there are fewer reports of AL safety in the first trimester, additional data are required to assess the potential to use AL in the first trimester. Though the available safety and efficacy data support the use of AL in the second and third trimesters, there is still a need for further information. These findings reinforce the WHO recommendation to treat uncomplicated falciparum malaria with quinine plus clindamycin in early pregnancy and ACT in later pregnancy.

【 授权许可】

CC BY   
© Manyando et al.; licensee BioMed Central Ltd. 2012