Artemether-lumefantrine to treat malaria in pregnancy is associated with reduced placental haemozoin deposition compared to quinine in a randomized controlled trial

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dc.contributor.authorMuehlenbachs, Atis
dc.contributor.authorNabasumba, Carolyn
dc.contributor.authorMcGready, Rose
dc.contributor.authorTuryakira, Eleanor
dc.contributor.authorTumwebaze, Benon
dc.contributor.authorDhorda, Mehul
dc.contributor.authorNyehangane, Dan
dc.contributor.authorNalusaji, Aisha
dc.contributor.authorNosten, François
dc.contributor.authorGuerin, Philippe J.
dc.contributor.authorPiola, Patrice
dc.date.accessioned2022-12-14T08:47:20Z
dc.date.available2022-12-14T08:47:20Z
dc.date.issued2012
dc.description.abstractData on efficacy of artemisinin-based combination therapy (ACT) to treat Plasmodium falciparum during pregnancy in sub-Saharan Africa is scarce. A recent open label, randomized controlled trial in Mbarara, Uganda demonstrated that artemether-lumefantrine (AL) is not inferior to quinine to treat uncomplicated malaria in pregnancy. Haemozoin can persist in the placenta following clearance of parasites, however there is no data whether ACT can influence the amount of haemozoin or the dynamics of haemozoin clearance. Methods: Women attending antenatal clinics with weekly screening and positive blood smears by microscopy were eligible to participate in the trial and were followed to delivery. Placental haemozoin deposition and inflammation were assessed by histology. To determine whether AL was associated with increased haemozoin clearance, population haemozoin clearance curves were calculated based on the longitudinal data. Results: Of 152 women enrolled in each arm, there were 97 and 98 placental biopsies obtained in the AL and quinine arms, respectively. AL was associated with decreased rates of moderate to high grade haemozoin deposition (13.3% versus 25.8%), which remained significant after correcting for gravidity, time of infection, re-infection, and parasitaemia. The amount of haemozoin proportionately decreased with the duration of time between treatment and delivery and this decline was greater in the AL arm. Haemozoin was not detected in one third of biopsies and the prevalence of inflammation was low, reflecting the efficacy of antenatal care with early detection and prompt treatment of malaria. Conclusions: Placental haemozoin deposition was decreased in the AL arm demonstrating a relationship between pharmacological properties of drug to treat antenatal malaria and placental pathology at delivery. Histology may be considered an informative outcome for clinical trials to evaluate malaria control in pregnancy. Trial registration: REGISTRY: http://clinicaltrials.gov/ct2/show/NCT00495508en_US
dc.identifier.citationMuehlenbachs, A., Nabasumba, C., McGready, R., Turyakira, E., Tumwebaze, B., Dhorda, M., ... & Piola, P. (2012). Artemether-lumefantrine to treat malaria in pregnancy is associated with reduced placental haemozoin deposition compared to quinine in a randomized controlled trial. Malaria journal, 11(1), 1-9.en_US
dc.identifier.urihttps://link.springer.com/article/10.1186/1475-2875-11-150
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/6277
dc.language.isoenen_US
dc.publisherMalaria journalen_US
dc.subjectMalaria in pregnancyen_US
dc.subjectPlacental malariaen_US
dc.subjectArtemisinin-based combination therapyen_US
dc.titleArtemether-lumefantrine to treat malaria in pregnancy is associated with reduced placental haemozoin deposition compared to quinine in a randomized controlled trialen_US
dc.typeArticleen_US
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