Artemisinin Combination for Postpartum Malaria
Trial question
What is the role of artemisinin combination therapy at the time of delivery in women in malaria endemic areas?
Study design
Multi-center
Open label
RCT
Population
151 female patients.
Inclusion criteria: women in malaria endemic areas after delivery.
Key exclusion criteria: positive peripheral blood slides at time of delivery; receipt of a study drug in the past 4 weeks; requiring medical or surgical intervention for complications during delivery; significant comorbidity; history of allergy or past reaction to any of the study drugs.
Interventions
N=80 artemisinin combination therapy (artemether/lumefantrine or dihydroartemisinin/piperaquine).
N=71 no treatment (follow-up assessment without any treatment).
Primary outcome
Slide-positive malaria at 6 months follow-up
21%
38%
38.0 %
28.5 %
19.0 %
9.5 %
0.0 %
Artemisinin combination
therapy
No
treatment
Significant
decrease ▼
NNT = 5
Significant decrease in slide-positive malaria at 6 months follow-up (21% vs. 38%; HR 0.49, 95% CI 0.27 to 0.9).
Secondary outcomes
Significant decrease in slide- and/or PCR-positive malaria during follow-up (51% vs. 63%; RR 0.81, 95% CI 0.07 to 1.55).
No significant difference in slide- and/or PCR-positive P. falciparum during follow-up (35% vs. 46%; RR 0.76, 95% CI -0.17 to 1.69).
No significant difference in improvement in mean hemoglobin concentration at 6 months (14.5 g/L vs. 14.7 g/L; MD 0.6, 95% CI -3.5 to 4.6).
Safety outcomes
No significant difference in adverse events.
Conclusion
In women in malaria endemic areas after delivery, artemisinin combination therapy was superior to no treatment with respect to a slide-positive malaria at 6 months follow-up.
Reference
Paula Tesine, Sze-Ann Woon, Moses Laman et al. Artemisinin combination therapy at delivery to prevent postpartum malaria: a randomized open-label controlled trial.: Preventing postpartum malaria. Int J Infect Dis. 2024 Dec:149:107258.
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