Efficacy and tolerability of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy: a systematic review and individual patient data meta-analysis
Review of 19 studies representing 92% patients in literature (4968 of 5360 episodes) found risk of PCR-corrected treatment failure higher for quinine monotherapy but lower for artesunate (AT)-amodiaquine, AT-mefloquine & dihydroartemisinin-piperaquine than artemether-lumefantrine
Source:
The Lancet Infectious Diseases
SPS commentary:
According to a commentary, although only 33 of 4968 total episodes in the meta-analysis were in their first trimester, there is no evidence to suggest that the relative efficacy of antimalarials in the first trimester would differ from treatment later in pregnancy. It notes that it is difficult to draw conclusions regarding safety given the very small number of first-trimester pregnancies. However, the safety of artemisinin-based combination therapy in pregnancy is supported by data for 30,618 pregnancies (947 exposed to quinine and 717 exposed to ACTs in the first trimester) that showed risk of miscarriage and stillbirth are similar between ACTs and quinine.