English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Tools annual

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Presents the access of premium content as premium feature

Premium Content

Global: Zendy Plus annual

Global: Zendy Free Plan

Background  Artemisinin and artemisinin-based combination therapy (ACT) partner drug resistance in  Plasmodium falciparum  have spread across the Greater Mekong Subregion compromising antimalarial treatment. The current 3-day artemether-lumefantrine regimen has been associated with high treatment failure rates in pregnant women. Although ACTs are recommended for treating  Plasmodium vivax  malaria, no clinical trials in pregnancy have been reported.    Methods  Pregnant women with uncomplicated malaria on the Thailand-Myanmar border participated in an open-label randomized controlled trial comparing dihydroartemisinin-piperaquine (DP), artesunate-mefloquine (ASMQ) and a 4-day artemether-lumefantrine regimen (AL + ). The primary endpoint for  P. falciparum  infections was the PCR-corrected cure rate and for  P. vivax  infections was recurrent parasitaemia, before delivery or day 63, whichever was longer, assessed by Kaplan-Meier estimate.    Results  Between February 2010 and August 2016, 511 pregnant women with malaria (353  P. vivax , 142  P. falciparum , 15 co-infections, 1  Plasmodium malariae ) were randomized to either DP ( n =170), ASMQ ( n =169) or AL +  ( n =172) treatments. Successful malaria elimination efforts in the region resulted in premature termination of the trial. The majority of women had recurrent malaria (mainly  P. vivax  relapses, which are not prevented by these treatments). Recurrence-free proportions (95% confidence interval [95% CI]) for vivax malaria were 20.6% (5.1–43.4) for DP ( n =125), 46.0% (30.9–60.0) for ASMQ ( n =117) and 28.7% (10.0–50.8) for AL +  ( n =126). DP and ASMQ provided longer recurrence-free intervals. PCR-corrected cure rates (95% CI) for falciparum malaria were 93.7% (81.6–97.9) for DP ( n =49), 79.6% (66.1–88.1) for AMSQ ( n =55) and 87.5% (74.3–94.2) for AL +  ( n =50). Overall 65% (85/130) of  P. falciparum  infections had  Pfkelch13  propeller mutations which increased over time and recrudescence occurred almost exclusively in them; risk ratio 9.42 (95% CI 1.30–68.29). Among the women with falciparum malaria, 24.0% (95% CI 16.8–33.6) had  P. vivax  parasitaemia within 4 months. Nausea, vomiting, dizziness and sleep disturbance were more frequent with ASMQ. Miscarriage, small-for-gestational-age and preterm birth did not differ significantly among the treatment groups, including first trimester exposures ( n =46).    Conclusions  DP was well tolerated and safe, and was the only drug providing satisfactory efficacy for  P. falciparum -infected pregnant woman in this area of widespread artemisinin resistance. Vivax malaria recurrences are very common and warrant chloroquine prophylaxis after antimalarial treatment in this area.    Trial registration   ClinicalTrials.gov  identifier  NCT01054248 , registered on 22 January 2010.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12916-021-02002-8.

bmc medicine

A randomized controlled trial of dihydroartemisinin-piperaquine, artesunate-mefloquine and extended artemether-lumefantrine treatments for malaria in pregnancy on the Thailand-Myanmar border