Dihydroartemisinin-piperaquine versus Sulfadoxine-pyrimethamine for
malaria during pregnancy: A systematic review and meta-analysis of
randomized controlled trials
Abstract
Abstract Background Malaria in pregnancy is one of the serious global
problems of our time. There were wide concerns about IPT-DP versus
IPT-SP for prevention of malaria during pregnancy. Objectives To assess
the current latest evidence on the efficacy and safety of
dihydroartemisinin-piperaquine versus sulfadoxine-pyrimethamine for
malaria in pregnancy. Search Strategy The Cochrane Library, EMBASE,
PubMed and Web of science were searched from the earliest publication
date available to July 4, 2019 Selection Criteria We included randomized
controlled trials comparing dihydroartemisinin-piperaquine with
sulfadoxine-pyrimethamine for malaria in pregnancy. Data Collection and
Analysis Outcomes were analyzed using Risk ratios (RR) and 95%
confidence intervals (CI). We did subgroup analysis about different
intervals, including 4-6 or 8 weeks. Main Results A total of five
studies with 4660 HIV-uninfected pregnant women in area of high
malaria-transmission intensity were included in final synthesis.
Meta-analysis showed dihydroartemisinin-piperaquine for intermittent
preventive treatment resulted in lower rates of placental malaria
(RR=0.50; 95%CI, 0.43–0.59) and infection with malaria parasites at
delivery (RR=0.05; 95%CI, 0.01–0.24). In the subgroup analysis,
dihydroartemisinin-piperaquine for intermittent preventive treatment at
4-6 weeks of administration was associated with a better effect for
infection with malaria parasites at delivery. Conclusions
Dihydroartemisinin-piperaquine was a promising alternative drug to
sulfadoxine-pyrimethamine for intermittent preventive treatment in
settings with high sulfadoxine-pyrimethamine resistance, especially at
4-6 weeks of administration. Based on real-world and other
epidemiological settings, more data will be needed to identify the risk
of adverse effects.