Publication: Piperaquine pharmacokinetics during intermittent preventive treatment for malaria in pregnancy
Issued Date
2021-03-01
Resource Type
ISSN
10986596
00664804
00664804
Other identifier(s)
2-s2.0-85101749755
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Antimicrobial Agents and Chemotherapy. Vol.65, No.3 (2021)
Suggested Citation
Palang Chotsiri, Julie R. Gutman, Rukhsana Ahmed, Jeanne Rini Poespoprodjo, Din Syafruddin, Carole Khairallah, Puji B.S. Asih, Anne L'lanziva, Kephas Otieno, Simon Kariuki, Peter Ouma, Vincent Were, Abraham Katana, Ric N. Price, Meghna Desai, Feiko O. ter Kuile, Joel Tarning Piperaquine pharmacokinetics during intermittent preventive treatment for malaria in pregnancy. Antimicrobial Agents and Chemotherapy. Vol.65, No.3 (2021). doi:10.1128/AAC.01150-20 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78394
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Piperaquine pharmacokinetics during intermittent preventive treatment for malaria in pregnancy
Other Contributor(s)
Faculty of Tropical Medicine, Mahidol University
Kenya Medical Research Institute
Eijkman Institute for Molecular Biology
Universitas Gadjah Mada
Menzies School of Health Research
Centers for Disease Control and Prevention
Liverpool School of Tropical Medicine
Nuffield Department of Medicine
Papuan Health and Community Development Foundation
Mimika District Health Authority
Kenya Medical Research Institute
Eijkman Institute for Molecular Biology
Universitas Gadjah Mada
Menzies School of Health Research
Centers for Disease Control and Prevention
Liverpool School of Tropical Medicine
Nuffield Department of Medicine
Papuan Health and Community Development Foundation
Mimika District Health Authority
Abstract
Dihydroartemisinin-piperaquine (DP) is a long-acting artemisinin combination treatment that provides effective chemoprevention and has been proposed as an alternative antimalarial drug for intermittent preventive therapy in pregnancy (IPTp). Several pharmacokinetic studies have shown that dose adjustment may not be needed for the treatment of malaria in pregnancy with DP. However, there are limited data on the optimal dosing for IPTp. This study aimed to evaluate the population pharmacokinetics of piperaquine given as IPTp in pregnant women. Pregnant women were enrolled in clinical trials conducted in Kenya and Indonesia and treated with standard 3-day courses of DP, administered in 4- to 8-week intervals from the second trimester until delivery. Pharmacokinetic blood samples were collected for piperaquine drug measurements before each treatment round, at the time of breakthrough symptomatic malaria, and at delivery. Piperaquine population pharmacokinetic properties were investigated using nonlinear mixed-effects modeling with a prior approach. In total, data from 366 Kenyan and 101 Indonesian women were analyzed. The pharmacokinetic properties of piperaquine were adequately described using a flexible transit absorption (n = 5) followed by a three-compartment disposition model. Gestational age did not affect the pharmacokinetic parameters of piperaquine. After three rounds of monthly IPTp, 9.45% (95% confidence interval [CI], 1.8 to 26.5%) of pregnant women had trough piperaquine concentrations below the suggested target concentration (10.3 ng/ml). Translational simulations suggest that providing the full treatment course of DP at monthly intervals provides sufficient protection to prevent malaria infection. Monthly administration of DP has the potential to offer optimal prevention of malaria during pregnancy.