Comparative effect of chemoprevention in malaria infection during pregnancy: A network meta-analysis

This study aimed to synthesize evidence on the relative effectiveness of antimalarial drugs used as chemoprevention of malaria in pregnancy (MIP) using network meta-analysis (NMA).

Searches for eligible studies were made in multiple electronic databases, including PubMed. Randomized controlled trials (RCTs) that studied chemoprevention as intermittent preventive treatment of malaria during pregnancy (IPTp) compared to placebo or to another active antimalarial drug were included. A pair-wise as well as an NMA were performed for each comparison. The certainty of evidence was rated with GRADE.

We included 22 RCTs (N = 14 705). Eight studies were rated as high risk of bias. The common comparator for this NMA was placebo or IPTp with dihydroartemisinin-piperaquine (DP). There is moderate certainty evidence that monthly single-dose IPTp-sulphadoxine/pyrimethamine (IPTp-SP) resulted in a greater reduction in maternal parasitaemia and anaemia compared to the placebo. However, there is low-certainty evidence of fewer incidences of low birth weight with IPTp-SP than with the combined DP and azithromycin.

The findings suggest that there is moderate certainty of evidence of the effect of IPTp-SP monthly single dose on maternal parasitaemia and anaemia. Future research should include a head-to-head comparison with adequate samples and evaluate the effectiveness, safety, operational feasibility and cost-effectiveness of IPTp for SP, DP, azithromycin and other potential antimalarials as either monotherapy or combination therapy. Information from endemic regions outside Africa, such as Asia and Latin America, is recommended.