Pharmacokinetics of Artesunate and Dihydroartemisinin in Pregnant and Non-Pregnant Women
Author Information
Author(s): Morris Carrie A, Onyamboko Marie A, Capparelli Edmund, Koch Matthew A, Atibu Joseph, Lokomba Vicky, Douoguih Macaya, Hemingway-Foday Jennifer, Wesche David, Ryder Robert W, Bose Carl, Wright Linda, Tshefu Antoinette K, Meshnick Steven, Fleckenstein Lawrence
Primary Institution: University of Iowa, College of Pharmacy
Hypothesis
How does pregnancy affect the pharmacokinetics of artesunate and its metabolite dihydroartemisinin?
Conclusion
Pregnant women have accelerated clearance of dihydroartemisinin compared to non-pregnant women, suggesting higher doses of artesunate may be needed during pregnancy.
Supporting Evidence
- Pregnant women showed a 42.3% increase in dihydroartemisinin clearance compared to non-pregnant women.
- The pharmacokinetic model developed was stable and predictive for both pregnant and non-pregnant women.
- Previous studies indicated lower exposure to dihydroartemisinin in pregnant women compared to non-pregnant adults.
Takeaway
When pregnant women take a malaria medicine, their bodies process it faster than when non-pregnant women take the same medicine, so they might need more of it.
Methodology
The study involved 26 pregnant women and 25 non-pregnant controls who received 200 mg of artesunate, with pharmacokinetic parameters estimated using nonlinear mixed effects modeling.
Limitations
The study's findings may not apply to pregnant women with acute symptomatic malaria, and the postpartum data were highly variable.
Participant Demographics
Pregnant women aged 18-40, asymptomatic with low-grade parasitaemia; non-pregnant controls matched for age.
Statistical Information
P-Value
0.001
Confidence Interval
19.7 - 72.3
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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