Falciparum malaria is the most dangerous type of malaria caused by parasite Plasmodium falciparum. The disease is associated with high levels of parasites in the blood and has the highest mortality rate among all types of malaria. During pregnancy, malaria affects both the mother and the fetus. This study aims to compare the efficacy of artemisinin-based and quinine-based treatments for maternal uncomplicated falciparum malaria.
This systematic review and meta-analysis included 18 randomized trials from seven databases and two clinical trial registries. Studies that evaluated PCR-corrected efficacy in pregnant women were included. The primary outcomes of the study were PCR-corrected & PCR-uncorrected efficacy, parasite clearance, and adverse outcomes.
The findings suggested that the risk of PCR-corrected treatment failure was significantly higher for quinine-based monotherapy (n=244, adjusted hazard ratio 6.11), as compared with artemisinin-based treatments (artesunate-amodiaquine [0.27], dihydroartemisinin-piperaquine [0.35], and artesunate-mefloquine [0.56]). The only treatment-related adverse event was gametocyte carriage. The risk of gametocyte carriage at day 7 was higher for quinine-based therapy than for artemisinin-based treatment (adjusted odds ration 7.38).
The research concluded that the efficacy and safety of artemisinin-based therapies were higher in pregnant women with uncomplicated falciparum malaria, as compared with quinine-based therapies.