Saturday, 13 April 2013

MALARIA: trial of azithromycin and chloroquine fixed-dose combination in pregnant women in Africa

Richa S Chandra, John Orazem, David Ubben, Stephan Duparc, Jeffery Robbins and Pol Vandenbroucke

Malaria Journal 2013, 12:122 doi:10.1186/1475-2875-12-122
Published: 11 April 2013

Abstract (provisional)


Malaria in pregnancy is one of the most common preventable causes of maternal and neonatal morbidity and mortality in sub-Saharan Africa. To prevent its adverse effects, such as maternal anaemia, placental parasitaemia and low birth weight (LBW) neonates, the World Health Organization recommends effective malaria case management, use of insecticide-treated bed nets and intermittent preventive therapy in pregnancy (IPTp). Sulphadoxine-pyrimethamine (SP) has been the standard for IPTp in several countries, but parasite resistance to SP is growing. Therefore, new IPTp therapies are urgently needed. One candidate being evaluated for IPTp is a fixed-dose combination of azithromycin and chloroquine (AZCQ). This paper describes the challenges and the innovative solutions implemented in designing and conducting a pivotal AZCQ-IPTp trial, sponsored by Pfizer Inc and co-funded by Pfizer Inc and the Medicines for Malaria Venture.


The AZCQ-IPTp pivotal trial is a multicentre, multicountry, phase III, open-label, randomized superiority study of AZCQ-IPTp versus SP-IPTp in pregnant women of sub-Saharan Africa. The trial was designed to meet stringent regulatory agency scientific advice and IPTp policy makers' recommendations, and incorporates an innovative adaptive design to manage programme risk, maintain the operating characteristics of the study and optimize resources. The trial's novel composite primary endpoint is the proportion of participants with a suboptimal pregnancy outcome (abortion [<=28 weeks], stillbirths [>28 weeks], premature [<37 100="" 1="" 50="" 70="" a="" achieve="" across="" adaptive="" after="" analyses="" and="" approximately="" arms="" assessments.="" based="" be="" birth="" blinded="" complete="" completion="" data="" deliveries="" design="" div="" employs="" endpoint="" follow-up="" g="" group="" lbw="" live="" loss="" missing="" neonatal="" neonates="" number="" observed="" of="" on="" or="" participants="" pooled="" primary="" prospective="" randomized="" remain="" review="" sequential="" study.="" study="" team="" the="" three="" to="" treatment="" two="" unblinded="" until="" weeks="" weight="" when="" will="" with="">


This study is ongoing and expected to complete in 2014.


This report describes the unique challenges and innovative solutions implemented in designing and conducting this pivotal AZCQ-IPTp trial, which may serve as a prototype for future IPTp and other studies involving similar conditions.

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