A fresh look at the role of spiramycin in preventing a neglected disease: meta-analyses of observational studies

Abstract

Abstract Purpose We aimed to investigate the effect of antepartum treatment with spiramycin with or without subsequent pyrimethamine–sulfonamide–folinic acid, compared to no treatment, on the rate of mother-to-child transmission (MTCT) of Toxoplasma gondii (T. gondii) and incidence/severity of sequelae in the offspring. Methods Embase and PubMed were searched for literature on spiramycin in pregnant women suspected/diagnosed with T. gondii infection. Meta-analyses were performed using random-effects model. Results Thirty-three studies (32 cohorts and 1 cross-sectional study), with a total of 15,406 mothers and 15,250 offspring, were pooled for analyses. The MTCT rate for all treated patients was significantly lower than the untreated [19.5% (95% CI 14–25.5%) versus 50.7% (95% CI 31.2–70%), p < 0.001]. The transmission rate in patients on spiramycin monotherapy was also significantly lower than untreated [17.6% (95% CI 9.9–26.8%) versus 50.7% (95% CI 31.2–70%), p < 0.001]. Conclusion Results indicate significant reduction in MTCT rates following spiramycin treatment of suspected/diagnosed maternal T. gondii infection.

Keywords

• Spiramycin
• Toxoplasmosis
• Systemic protozoa
• Sequelae
• Mortality
• Transmission