Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study

Osede I Iribhogbe,1 Igue Emmanuel,2 Marylove Odianosen2 1Department of Pharmacology and Therapeutics, 2Department of Human Physiology College of Medicine, Ambrose Alli University Ekpoma, Edo State, Nigeria Abstract: A comparative clinical study was conducted to evaluate the safety and toler...

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Autores principales: Iribhogbe OI, Emmanuel I, Odianosen M
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Publicado: Dove Medical Press 2017
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spelling oai:doaj.org-article:e29b57d22ff84ab595de8a275e1360492021-12-02T02:29:11ZComparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study1179-1438https://doaj.org/article/e29b57d22ff84ab595de8a275e1360492017-05-01T00:00:00Zhttps://www.dovepress.com/comparative-analysis-of-the-safety-and-tolerability-of-fixed-dose-arte-peer-reviewed-article-CPAAhttps://doaj.org/toc/1179-1438Osede I Iribhogbe,1 Igue Emmanuel,2 Marylove Odianosen2 1Department of Pharmacology and Therapeutics, 2Department of Human Physiology College of Medicine, Ambrose Alli University Ekpoma, Edo State, Nigeria Abstract: A comparative clinical study was conducted to evaluate the safety and tolerability of two commonly used fixed dose artemisinin-based combinations for the treatment of uncomplicated Plasmodium falciparum malaria in the second and third trimester of pregnancy. To achieve this, a total of 155 participants were recruited for the study. Eighty of these were drawn from pregnant women who came for routine antenatal care while 40 nonpregnant participants were recruited from apparently healthy females in the community. Eighty pregnant participants with uncomplicated P. falciparum malaria were randomized into artesunate/amodiaquine (AA) and artemether/lumefantrine (AL) treatment arms while 40 nonpregnant and 35 nonmalarious pregnant women were used as control. The interventional groups received standard fixed dose combinations of AA (100/270 mg) daily or AL (20/120 mg) twice daily for 3 days. Blood samples were collected on day 4 and patients were followed-up closely to ascertain the safety of the drugs. The study showed a significant (p<0.0001) elevation of alkaline phosphatase in the AA and AL group compared to the nonpregnant control and a significant (p<0.05) elevation of alanine transaminase and aspartate transaminase level in the AL combination group when compared with the AA group. The elevated hepatic enzymes were within the normal range for pregnancy and were not clinically significant. Adverse event rate was higher in the AA group (n=28 [70%]) when compared to the AL group (n=4 [10%]) although the drugs were well-tolerated in both treatment arms. In conclusion, the use of these combinations is safe in the second and third trimester of pregnancy. However, we recommend active pharmacovigilance and spontaneous drug reporting of the agents in order to continuously monitor safety in the vastly heterogeneous population. Keywords: fixed dose combination, Plasmodium falciparum malaria, safety, pregnancy, tolerance, pharmacovigilanceIribhogbe OIEmmanuel IOdianosen MDove Medical PressarticleFixed dose combinationP. falciparum malariaSafetyPregnancyTolerancePharmacovigilanceTherapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol Volume 9, Pp 45-54 (2017)
institution DOAJ
collection DOAJ
language EN
topic Fixed dose combination
P. falciparum malaria
Safety
Pregnancy
Tolerance
Pharmacovigilance
Therapeutics. Pharmacology
RM1-950
spellingShingle Fixed dose combination
P. falciparum malaria
Safety
Pregnancy
Tolerance
Pharmacovigilance
Therapeutics. Pharmacology
RM1-950
Iribhogbe OI
Emmanuel I
Odianosen M
Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
description Osede I Iribhogbe,1 Igue Emmanuel,2 Marylove Odianosen2 1Department of Pharmacology and Therapeutics, 2Department of Human Physiology College of Medicine, Ambrose Alli University Ekpoma, Edo State, Nigeria Abstract: A comparative clinical study was conducted to evaluate the safety and tolerability of two commonly used fixed dose artemisinin-based combinations for the treatment of uncomplicated Plasmodium falciparum malaria in the second and third trimester of pregnancy. To achieve this, a total of 155 participants were recruited for the study. Eighty of these were drawn from pregnant women who came for routine antenatal care while 40 nonpregnant participants were recruited from apparently healthy females in the community. Eighty pregnant participants with uncomplicated P. falciparum malaria were randomized into artesunate/amodiaquine (AA) and artemether/lumefantrine (AL) treatment arms while 40 nonpregnant and 35 nonmalarious pregnant women were used as control. The interventional groups received standard fixed dose combinations of AA (100/270 mg) daily or AL (20/120 mg) twice daily for 3 days. Blood samples were collected on day 4 and patients were followed-up closely to ascertain the safety of the drugs. The study showed a significant (p<0.0001) elevation of alkaline phosphatase in the AA and AL group compared to the nonpregnant control and a significant (p<0.05) elevation of alanine transaminase and aspartate transaminase level in the AL combination group when compared with the AA group. The elevated hepatic enzymes were within the normal range for pregnancy and were not clinically significant. Adverse event rate was higher in the AA group (n=28 [70%]) when compared to the AL group (n=4 [10%]) although the drugs were well-tolerated in both treatment arms. In conclusion, the use of these combinations is safe in the second and third trimester of pregnancy. However, we recommend active pharmacovigilance and spontaneous drug reporting of the agents in order to continuously monitor safety in the vastly heterogeneous population. Keywords: fixed dose combination, Plasmodium falciparum malaria, safety, pregnancy, tolerance, pharmacovigilance
format article
author Iribhogbe OI
Emmanuel I
Odianosen M
author_facet Iribhogbe OI
Emmanuel I
Odianosen M
author_sort Iribhogbe OI
title Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
title_short Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
title_full Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
title_fullStr Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
title_full_unstemmed Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
title_sort comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study
publisher Dove Medical Press
publishDate 2017
url https://doaj.org/article/e29b57d22ff84ab595de8a275e136049
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