Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials.
Intermittent screening and treatment with artemisinin-combination therapy versus intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria in pregnancy: a systematic review and individual participant data meta-analysis of randomised clinical trials.
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DOI：
10.1016/j.eclinm.2021.101160
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发表时间：
2021-11
影响因子：
15.1
通讯作者：
Ter Kuile FO
中科院分区：
文献类型：
--
作者：
Gutman JR;Khairallah C;Stepniewska K;Tagbor H;Madanitsa M;Cairns M;L'lanziva AJ;Kalilani L;Otieno K;Mwapasa V;Meshnick S;Kariuki S;Chandramohan D;Desai M;Taylor SM;Greenwood B;Ter Kuile FO
在撒哈拉以南非洲，使用磺胺嘧啶-乙胺嘧啶对妊娠期疟疾进行间歇性预防性治疗的效果受到寄生虫抗药性的威胁。我们进行了一项个体参与者数据（IPD）荟萃分析，以评估疟疾快速诊断测试（RDTs）间歇性筛查和青蒿素联合治疗（ISTP-ACT）与IPTP-SP治疗RDT阳性女性的疗效，并了解隐性感染的重要性。我们于2021年5月6日检索了MEDLINE和妊娠期疟疾图书馆，以比较ISTP-ACT和IPTP-SP的试验。使用广义线性回归来比较不良妊娠结局（小于胎龄儿、低出生体重（LBW）或早产的复合结局）和分娩时外周或胎盘恶性疟原虫。使用多变量固定效应模型对两组合并的亚专利（PCR阳性，RDT/显微镜阴性）感染的影响进行了评估，该模型对专利感染的数量进行了调整。PROSPERO注册：CRD 42016043789。2007年至2014年期间进行的五项试验（10，821例妊娠）做出了贡献，其中两项来自高SP抗性地区，dhfr/dhps五倍突变体寄生虫饱和，但六倍突变体仍然罕见（肯尼亚和马拉维），三项来自低抗性地区（西非）。4项试验提供了IPD数据（N= 10，362）。分娩时，任何疟疾感染的患病率（相对危险度[RR]=1.08，95%CI 1.00-1.16，I2= 67.0%）和未感染的患病率（RR=1.02，0.61-1.16，I2=0.0%）相似。未闭感染在ISTp受者中更常见（RR=1.31，1.05-1.62，I2=0.0%）。不良妊娠结局无差异（RR=1.00，0.96-1.05;研究=4，N= 9，191，I2=54.5%）。隐性感染与LBW（校正RR=1.13，1.07-1.19）、较低平均出生体重（校正平均差异= 32 g，15-49）和早产（aRR=1.35，1.15-1.57）相关。ISTp-ACT并不上级于IPTp-SP，并且可能导致比现有IPTp-SP策略更多的亚专利感染。隐性感染与LBW增加和早产有关。需要更敏感的诊断测试来检测和治疗低度感染。疾病控制和预防中心和全球抗疟药抵抗网络。
In sub-Saharan Africa, the efficacy of intermittent preventive therapy in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) for malaria in pregnancy is threatened by parasite resistance. We conducted an individual-participant data (IPD) meta-analysis to assess the efficacy of intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with artemisinin-based combination therapy (ISTp-ACT) compared to IPTp-SP, and understand the importance of subpatent infections. We searched MEDLINE and the Malaria-in-Pregnancy Library on May 6, 2021 for trials comparing ISTp-ACT and IPTp-SP. Generalised linear regression was used to compare adverse pregnancy outcomes (composite of small-for-gestational-age, low birthweight (LBW), or preterm delivery) and peripheral or placental Plasmodium falciparum at delivery. The effects of subpatent (PCR-positive, RDT/microscopy-negative) infections were assessed in both arms pooled using multi-variable fixed-effect models adjusting for the number of patent infections. PROSPERO registration: CRD42016043789. Five trials conducted between 2007 and 2014 contributed (10,821 pregnancies), two from high SP-resistance areas where dhfr/dhps quintuple mutant parasites are saturated, but sextuple mutants are still rare (Kenya and Malawi), and three from low-resistance areas (West-Africa). Four trials contributed IPD data (N=10,362). At delivery, the prevalence of any malaria infection (relative risk [RR]=1.08, 95% CI 1.00-1.16, I2=67.0 %) and patent infection (RR=1.02, 0.61-1.16, I2=0.0%) were similar. Subpatent infections were more common in ISTp recipients (RR=1.31, 1.05-1.62, I2=0.0%). There was no difference in adverse pregnancy outcome (RR=1.00, 0.96-1.05; studies=4, N=9,191, I2=54.5%). Subpatent infections were associated with LBW (adjusted RR=1.13, 1.07-1.19), lower mean birthweight (adjusted mean difference=32g, 15-49), and preterm delivery (aRR=1.35, 1.15-1.57). ISTp-ACT was not superior to IPTp-SP and may result in more subpatent infections than the existing IPTp-SP policy. Subpatent infections were associated with increased LBW and preterm delivery. More sensitive diagnostic tests are needed to detect and treat low-grade infections. Centers for Disease Control and Prevention and Worldwide Antimalarial Resistance Network.
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影响因子：
56.3
作者：
Ahmed, Rukhsana;Poespoprodjo, Jeanne R.;ter Kuile, Feiko O.
通讯作者：
ter Kuile, Feiko O.
影响因子：
3
作者：
Esu, Ekpereonne;Berens-Riha, Nicole;Meremikwu, Martin
通讯作者：
Meremikwu, Martin
DOI：
10.1073/pnas.0901415106
发表时间：
2009-06-02
影响因子：
11.1
作者：
Harrington, W. E.;Mutabingwa, T. K.;Duffy, P. E.
通讯作者：
Duffy, P. E.
影响因子：
17.1
作者：
Bourke, Claire D.;Gough, Ethan K.;Prendergast, Andrew J.
通讯作者：
Prendergast, Andrew J.
影响因子：
15.8
作者：
Elphinstone, Robyn E.;Weckman, Andrea M.;Kain, Kevin C.
通讯作者：
Kain, Kevin C.