Comparative effectiveness of antimalarial drugs for chemoprevention of malaria in pregnancy: A Network Meta-Analysis

Abstract

Comparative effectiveness of antimalarial drugs for chemoprevention of malaria in pregnancy: A network meta-analysis Introduction Malaria is a vector -borne parasitic infection. There are currently five species of the Plasmodium parasite that cause human malaria. Malaria during pregnancy can attribute to maternal related outcomes such as maternal anaemia, stillbirth and parasitological outcomes such as peripheral parasitaemia, placental parasitaemia. These consequences can be interrupted by chemoprevention of malaria with appropriate and recommended drugs. Methods We performed a network meta-analysis (NMA), following PRISMA-NMA checklist followed by GRADE approach for overall certainty. Results The present NMA included 12 randomised controlled trials with 2238 participants across 8 malaria endemic countries in the African and South-East Asia regions. These studies assessed 5 antimalarial drugs such as Chloroquine (CQ), Sulfadoxine–pyrimethamine (SP), Proguinil, Pyrimethamine alone, Pyrimethamine‐dapson (Pyr_dapson). The most frequently used drug was SP twice per week administration. The majority of included studies were with low risk of bias in the blinding status, but unclear/high risk of bias in allocation concealment and randomization process of the RCTs. Proguinil and SP (weekly dose) or CQ and placebo had comparable efficacy in reduction of parasitemia in mother, indicating that CQ has no benefit of chemoprevention for malaria in pregnancy. All intervention drugs were not with better efficacy for still births than placebo. According to the GRADE rating the evidence was of moderate certainty that the true effect of CQ is likely to be close to the estimate both the effect of parasite and stillbirth, but there is a possibility that it is substantially different in malaria with pregnancy. Conclusion The findings suggest that the more potent drugs with better schedule (e.g weekly, intermittent etc) for chemoprevention of malaria in pregnancy MiP are required. As SP resistance to malaria parasite is well established, what alternative drugs would be introduced to MiP. A package of care including better quality of maternal and child health care services, ensure the nutritional status of pregnant women along with chemoprevention should be targeted towards the MiP. Keywords: Antimalarial drugs; Chemoprevention; Malaria in pregnancy; Network Metaanalysis