Methodological Concerns Regarding the Relation Between Mefloquine and Serious Psychiatric Events in Females

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Sir: van Riemsdijk et al.¹ report the results of a case-control study of serious psychiatric events related to mefloquine use among Dutch travelers. A highlighted result is a (startling) odds ratio (OR) of 47.1 (with very wide 95% CI of 3.8 to 578.6) for such events in females taking mefloquine.

While the basic case-control methodology of this study appears sound, we have concerns that would erode confidence in this study: (1) The overall response rate from cases and controls is felt, by the authors, to be high enough ("almost 70%") to avoid selection bias.' ‹