Prevention of Congenital Toxoplasmosis With Pyrimethamine + Sulfadiazine Versus Spiramycine During Pregnancy
- Conditions
- Congenital Toxoplasmosis
- Interventions
- Drug: Pyrimethamine/SulfadiazineDrug: Spiramycine
- Registration Number
- NCT01189448
- Lead Sponsor
- Assistance Publique - Hôpitaux de Paris
- Brief Summary
Background : When a mother contracts toxoplasmosis during pregnancy, the parasite may be transmitted from to her unborn child. This results in congenital toxoplasmosis, which may cause damage to the eyes and nervous system of the child. To date, no method has been proved effective to prevent this transmission. In France, spiramycin is usually prescribed to women who have toxoplasma seroconversion in pregnancy, however its efficacy has not been determined. The standard treatment for toxoplasmosis is the combination of the antiparasitic drugs pyrimethamine and sulfadiazine, but this strategy has not been evaluated for the prevention of mother-to-child transmission.
Purpose : Randomized phase 3 trial to determine whether pyrimethamine + sulfadiazine is more effective than spiramycin to prevent congenital toxoplasmosis.
- Detailed Description
The protocol is a comparison of 2 strategies to prevent mother-to-child transmission of T. gondii following maternal seroconversion.
Screening for toxoplasmosis is mandatory in France. Patients with confirmed seroconversion will be eligible for the trial, after 14 weeks gestational age.
Participants will be randomly allocated to one of the treatment groups, and will receive open-label pyrimethamine + sulfadiazine or spiramycin.
The protocol will not change the usual procedures for prenatal diagnosis, nor will it change the management of infected fetuses and neonates.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 149
- > 18 years old
- Toxoplasmosis infection acquired during the pregnancy documented by at least one negative serology in the first trimester and seroconversion with presence of specific IgG antibodies
- Gestational age > 14 weeks from last menstrual period
- Signature of informed consent
- Lack of a documented negative serology during the pregnancy
- Antiparasitic therapy with spiramycin, pyrimethamine or sulfa drugs for more than 10 days after seroconversion and before randomization,
- Known allergy to any of the study drugs, serious allergic conditions or G6PD deficiency,
- Known hepatic or renal insufficiency,
- Other ongoing severe conditions in mother or fetus
- Lack of public health insurance
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Pyrimethamine/Sulfadiazine Pyrimethamine/Sulfadiazine Women who are enrolled and randomised in Pyrimethamine + sulfadiazine group : Pyrimethamine 50 mg once daily orally and sulfadiazine 1g tid. orally, with supplemental folinic acid 50 mg once a week. Spiramycine Spiramycine Spiramycin group : spiramycin 1g tid orally
- Primary Outcome Measures
Name Time Method Rate of mother-to-child transmission Up to six months after birth Rate of mother-to-child transmission of toxoplasma gondii, determined by PCR on amniocentesis and/or synthesis of specific antibodies by the neonate
- Secondary Outcome Measures
Name Time Method Secondary Outcome Measure Up to six months after birth * Mother-to-child transmission rate according to the time between primary infection and start of therapy
* Tolerance in mothers and neonates (grade 3-4 toxicities)
* Severity of infection at birth in case of congenital toxoplasmosis (parasite load in amniotic fluid, clinical and biological signs)
Trial Locations
- Locations (1)
Hôpital Louis Mourier
🇫🇷Colombes, Hauts-de-Saine, France