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Safety of Antimalarials in the FIRst trimEster

RecruitingPhase 3Ages 16 Years - anyFemaleLiverpool School of Tropical Medicine
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In plain words

What the trial is, and whether it could suit you

The SAFIRE study aims to find effective treatments with acceptable safety for malaria in early pregnancy, a particularly sensitive time for the adverse consequences of malaria in pregnancy for both mother and baby. Currently, WHO recommends the antimalarial drug artemether-lumefantrine (AL) for the treatment of uncomplicated malaria in the first trimester of pregnancy. Other promising treatments are being rolled out in malaria-endemic countries for use in adults and children and data on current exposures in the first trimester are limited and insufficient to support a recommendation. This is due to the fact that pregnant women are often excluded from clinical trials to protect fetuses, unintentionally depriving them of newer, potentially better treatments. Instead, they often received older, less effective drugs. The International Council for Harmonisation (ICH E21) and stringent regulat

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📋 Eligibility rules (as published)
Inclusion Criteria: * ≥2 weeks and \<14 weeks (13-6/7 weeks inclusive) gestation from the last menstrual period (LMP) as assessed by echography * Microscopy confirmed P. falciparum mono or mixed infections, regardless of symptoms. * Emancipated minor and aged ≥16 years * Haemoglobin ≥ 7 g/dL * Residence within the health facility catchment area * Willingness to adhere to study requirements and to deliver the baby at the local health facility * Willingness to adhere to study requirements and to deliver the baby at the local health facility Exclusion Criteria: * Known allergy to any of the study drugs * History of known pregnancy complications or poor obstetric history, such as repeated miscarriages, stillbirths, or eclampsia * History or presence of major illnesses likely to influence pregnancy outcome * Known HIV positive * Any significant illness at the time of screening requiring hospitalisation, including severe malaria * Intent to move out of the study catchment area before delivery or planned delivery out of the catchment area * Recent (2 weeks) treatment with antimalarials or antimicrobials with antimalarial activity (chloroquine, AL, DP, PA, SPAQ, ASAQ, MQAS, azithromycin, clindamycin, tetracycline, quinolones, cotrimoxazole and SP) * Twin/multiple pregnancy detected * Non-viable pregnancy confirmed by ultrasound or doppler * Known history or evidence of clinically significant cardiovascular disorders or family history of sudden death or congenital long QT syndrome or current co administration of other drugs that might contribute to a prolonged QTc interval or cause "Torsades de Point" * Chronic medical condition requiring frequent medications (e.g., TB, suspected hepatic lesions, liver disease, sickle cell disease, diabetes, epilepsy, asthma and hypertension) * Prior randomisation in this study during the current pregnancy
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What it tests

  • dihydroartemisinin-piperaquine (DP)
  • Pyronaridine-artesunate (PA)
  • Artemether-lumefantrine
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Where

3 sites
Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest (IRSS-DRO)
Nanoro, Burkina Faso
KEMRI Centre for Global Health Research (CGHR)
Kisumu, Kenya
Malaria Research and Training Center, University of Sciences, Techniques, and Technologies of Bamako (USTTB),
Bamako, Mali
🤝 Taking part is your choice, and you can leave at any time. Only the trial team can confirm you are eligible — always decide together with your own doctor.
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