Mefloquine Versus Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment in Pregnancy: A Joint Analysis on Efficacy and Tolerability

Abstract

Abstract. Since there is no ideal candidate to replace sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPTp), alternatives need to be evaluated on basis of their benefit-risk ratio. We reanalyzed the first Beninese trial on mefloquine (MQ) versus SP for IPTp using a multiple outcome approach, which allowed the joint assessment of efficacy and tolerability. Overall superiority of MQ to SP was defined as superiority on at least one efficacy outcome (low birth weight [LBW], placental malaria, or maternal anemia), non-inferiority on all of them as well as on tolerability defined as cutaneous or neuropsychiatric adverse events (AEs) or low compliance with the treatment. The analysis included 1,601 women. MQ was found to be overall superior to SP (P = 0.004). Performing several sensitivity analyses to handle both missing data and stillbirths provided similar results. Using MQ for IPTp as an example, we show that a multiple outcome analysis is a pragmatic way to assess the benefits/disadvantages of one drug compared with another. In the current context of a lack of antimalarials that could be used for IPTp, such a statistical approach could be widely used by institutional policy makers for future recommendations regarding the prevention of malaria in pregnancy (MiP).

Comparative study of mefloquine and sulphadoxine–pyrimethamine for malaria prevention among pregnant women with HIV in southwest Nigeria

“…Although the differences were not significant, the present study agreed with that of Briand et al., who reported that mefloquine has efficacy comparable to that of sulphadoxine–pyrimethamine in the prevention of low delivery weight . There was no significant difference in the PCV of women in the mefloquine group compared with the sulphadoxine–pyrimethamine group, although other studies have reported mefloquine to be associated with improved maternal anemia at delivery …”

“…Assessing the benefit of a drug therapy requires consideration of both therapeutic and adverse effects. Briand et al . found that, despite having reasonable tolerance to mefloquine at prophylactic doses, 78% of women treated with mefloquine reported experiencing adverse events.…”

Mefloquine for preventing malaria in pregnant women

“…The report was excluded because it did not meet the inclusion criteria. Briand 2015 This publication reports the findings of a re‐analysis of previous published data comparing mefloquine with sulphadoxine‐pyrimethamine for IPTp in Benin using a multiple outcome approach, which allowed the joint assessment of efficacy and tolerability. 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.…”

Gestational malaria in Kisangani : Efficacy of Mefloquine vs Sulfadoxine-Pyrimethamine in Intermittent Preventive Treatment : A Study Protocol for a randomized controlled clinical trial

“…IPTp-MQ would reduce placental parasitaemia malaria, low birth weight of newborns, and maternal anemia at delivery. Some studies in other countries have shown that the efficacy of MQ is superior to that of SP in IPTp [26,29,36,37]. However, it has been reported that SP is better tolerated than MQ.…”