Tolerability of Mefloquine Intermittent Preventive Treatment for Malaria in HIV-Infected Pregnant Women in Benin

Denoeud-Ndam, Lise; Clément, Marie-Caroline; Briand, Valérie; Akakpo, Jocelyn; Agossou, Vidéhouénou K.; Atadokpèdé, F.; Dossou-Gbete, L.; Komongui, Didier G.; Afangnihoun, Aldric; Girard, Pierre‐Marie; Zannou, Djimon-Marcel; Cot, Michel

doi:10.1097/qai.0b013e3182615a58

Cited by 16 publications

(13 citation statements)

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“…Several studies have evidenced an association of maternal malaria, especially placental infection, with increased risk of clinical malaria and overall mortality in infants [ 1 , 2 , 4 , 6 , 11 , 61 – 63 ]. Although pregnant women who received IPTp with MQ had a lower incidence of clinical malaria and placental infection than those who received SP, the incidence of malaria and the all-cause mortality rate among their children were similar between the two groups and consistent with results reported from other studies in sub-Saharan Africa and are similar to those estimated in the region for the same age group [ 2 , 14 , 29 , 38 , 39 , 64 ]. In the only trial assessing the impact of MQ in pregnancy on malaria and all-cause mortality in children, the mortality rate and incidence of malaria episodes were comparable in both groups (malaria prophylaxis with either MQ or placebo) [ 27 ].…”

Section: Discussionsupporting

confidence: 87%

“…There is very limited data on the impact of MQ in pregnancy on the infant’s health status. Previous trials evaluating the safety and efficacy of MQ in pregnancy in the African region assessed only pregnancy outcomes or followed up children only until 1 mo after birth [ 37 – 39 ]. Only two trials—one carried out in the Thai–Burmese border area comparing MQ with placebo for malaria prophylaxis in pregnant Karen women and the other, in the same area, comparing MQ combined with AS with quinine for malaria treatment—have reported children’s outcomes for the first 24 and 12 mo of life, respectively [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

et al. 2016

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BackgroundLittle is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp) on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ) compared to sulfadoxine-pyrimethamine (SP) for important infant health and developmental outcomes.Methods and FindingsIn the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania), 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27%) from the MQ group and 377 (26%) from the SP group. Reasons for not completing the study were death (4% of total study population), study withdrawal (6%), migration (8%), and loss to follow-up (9%).ConclusionsNo significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve further studies.Trial registrationClinicalTrials.gov NCT00811421

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

et al. 2016

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“…Women were enrolled within the frame of the PACOME clinical trial, conducted in 5 urban hospitals in the South of Benin since December 2009 [14].…”

Section: Methodsmentioning

confidence: 99%

Predictive Factors of Plasma HIV Suppression during Pregnancy: A Prospective Cohort Study in Benin

Denoeud-Ndam

Fourcade²,

Ogouyèmi-Hounto³

et al. 2013

PLoS ONE

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ObjectiveTo investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin.DesignSub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT.MethodsHIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy.ResultsOverall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression.ConclusionsThis study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.

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“…This analysis was not included in the review because the original study (Briand 2009 BEN) was already included and it did not add additional data. Denoeud‐Ndam 2012 Study comparing mefloquine tolerability as IPTp between HIV‐infected and uninfected women participating in three included trials from Benin (Briand 2009 BEN and Denoeud‐Ndam 2014a and b). This analysis was excluded from the review because it did not provide additional data from already included trials.…”

Section: Characteristics Of Excluded Studies [Ordered By Study Id]mentioning

confidence: 99%

Mefloquine for preventing malaria in pregnant women

González

Pons‐Duran

Piqueras

et al. 2018

Cochrane Database of Systematic Reviews

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BackgroundThe World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine for malaria for all women who live in moderate to high malaria transmission areas in Africa. However, parasite resistance to sulfadoxine-pyrimethamine has been increasing steadily in some areas of the region. Moreover, HIV-infected women on cotrimoxazole prophylaxis cannot receive sulfadoxine-pyrimethamine because of potential drug interactions. Thus, there is an urgent need to identify alternative drugs for prevention of malaria in pregnancy. One such candidate is mefloquine.ObjectivesTo assess the effects of mefloquine for preventing malaria in pregnant women, specifically, to evaluate:the efficacy, safety, and tolerability of mefloquine for preventing malaria in pregnant women; andthe impact of HIV status, gravidity, and use of insecticide-treated nets on the effects of mefloquine.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, Latin American Caribbean Health Sciences Literature (LILACS), the Malaria in Pregnancy Library, and two trial registers up to 31 January 2018. In addition, we checked references and contacted study authors to identify additional studies, unpublished data, confidential reports, and raw data from published trials.Selection criteriaRandomized and quasi-randomized controlled trials comparing mefloquine IPT or mefloquine prophylaxis against placebo, no treatment, or an alternative drug regimen.Data collection and analysisTwo review authors independently screened all records identified by the search strategy, applied inclusion criteria, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when required. Dichotomous outcomes were compared using risk ratios (RRs), count outcomes as incidence rate ratios (IRRs), and continuous outcomes using mean differences (MDs). We have presented all measures of effect with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach for the following main outcomes of analysis: maternal peripheral parasitaemia at delivery, clinical malaria episodes during pregnancy, placental malaria, maternal anaemia at delivery, low birth weight, spontaneous abortions and stillbirths, dizziness, and vomiting.Main resultsSix trials conducted between 1987 and 2013 from Thailand (1), Benin (3), Gabon (1), Tanzania (1), Mozambique (2), and Kenya (1) that included 8192 pregnant women met our inclusion criteria.Two trials (with 6350 HIV-uninfected pregnant women) compared two IPTp doses of mefloquine with two IPTp doses of sulfadoxine-pyrimethamine. Two other trials involving 1363 HIV-infected women compared three IPTp doses of mefloquine plus cotrimoxazole with cotrimoxazole. One trial in 140 HIV-infected women compared three doses of IPTp-mefloquine with cotrimoxazole. Finally, one trial enrolling 339 of unknown HIV statu...

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Tolerability of Mefloquine Intermittent Preventive Treatment for Malaria in HIV-Infected Pregnant Women in Benin

Cited by 16 publications

References 28 publications

Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

Predictive Factors of Plasma HIV Suppression during Pregnancy: A Prospective Cohort Study in Benin

Mefloquine for preventing malaria in pregnant women

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