Mefloquine Versus Sulfadoxine–Pyrimethamine for Intermittent Preventive Treatment in Pregnancy: A Joint Analysis on Efficacy and Tolerability

Overall superiority of mefloquine (MQ) to sulfadoxine-pyrimethamine (SP) was observed in a trial involving 1,601 women (P = 0.004).

• Mefloquine was superior to sulfadoxine-pyrimethamine on at least one efficacy outcome, including low birth weight, placental malaria, or maternal anemia.
• Mefloquine was non-inferior to sulfadoxine-pyrimethamine on all efficacy outcomes and tolerability measures.
• Tolerability was defined by the presence of cutaneous or neuropsychiatric adverse events and low compliance with treatment.
• Multiple sensitivity analyses addressing missing data and stillbirths supported the conclusion of mefloquine's superiority.
• The approach of a multiple outcome analysis may provide a practical framework for evaluating drug benefits and risks in clinical settings.

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