Artemisinin-based combination therapy for ... - The Cochrane Library

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3 Total Failure (P. falciparum) Day 42 PCR unadjusted 1 152 Risk Ratio (M-H, Fixed, 95% CI) 0.27 [0.10, 0.72] 3.1 Asia 1 152 Risk Ratio (M-H, Fixed, 95% CI) 0.27 [0.10, 0.72] 4 Total Failure (P. falciparum) Day 42 PCR adjusted 1 141 Risk Ratio (M-H, Fixed, 95% CI) 0.10 [0.01, 0.81] 4.1 Asia 1 141 Risk Ratio (M-H, Fixed, 95% CI) 0.10 [0.01, 0.81] 5 P. vivax parasitaemia 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 5.1 Mixed P. falciparum and vivax infection at baseline 1 220 Risk Ratio (M-H, Fixed, 95% CI) 1.24 [0.67, 2.29] 5.2 P. vivax parasitaemia by day 28 1 181 Risk Ratio (M-H, Fixed, 95% CI) 0.45 [0.04, 4.90] 5.3 P. vivax parasitaemia by day 42 1 170 Risk Ratio (M-H, Fixed, 95% CI) 0.25 [0.09, 0.74] 6 Serious adverse events (including deaths) 1 334 Risk Ratio (M-H, Fixed, 95% CI) 0.14 [0.01, 2.71] 7 Early vomiting 1 334 Risk Ratio (M-H, Fixed, 95% CI) 0.53 [0.22, 1.30] Comparison 4. Dihydroartemisinin-piperaquine vs Artesunate plus sulfadoxine-pyrimethamine Outcome or subgroup title No. of studies No. of participants Statistical method Effect size 1 Total Failure (P. falciparum) Day 42 PCR unadjusted 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 1.1 Oceania 1 215 Risk Ratio (M-H, Fixed, 95% CI) 1.03 [0.74, 1.45] 2 Total Failure (P. falciparum) Day 42 PCR adjusted 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 2.1 Oceania 1 161 Risk Ratio (M-H, Fixed, 95% CI) 0.77 [0.39, 1.51] 3 Total Failure (P. falciparum) Day 28 PCR unadjusted 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 3.1 Oceania 1 223 Risk Ratio (M-H, Fixed, 95% CI) 1.01 [0.62, 1.64] 4 Total Failure (P. falciparum) Day 28 PCR adjusted 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 4.1 Oceania 1 195 Risk Ratio (M-H, Fixed, 95% CI) 1.01 [0.46, 2.22] 5 P. vivax parasitaemia by day 42 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 5.1 Participants with P. falciparum mono-infection at baseline 1 194 Risk Ratio (M-H, Fixed, 95% CI) 0.45 [0.32, 0.65] 5.2 Participants with P. vivax ± P. falciparum at baseline 1 75 Risk Ratio (M-H, Fixed, 95% CI) 0.46 [0.27, 0.79] Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 112
Comparison 5. Dihydroartemisinin-piperaquine vs Amodiaquine plus sulfadoxine-pyrimethamine Outcome or subgroup title No. of studies No. of participants Statistical method Effect size 1 Total Failure (P. falciparum) Day 28 PCR unadjusted 2 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 1.1 Africa 2 848 Risk Ratio (M-H, Fixed, 95% CI) 0.37 [0.25, 0.55] 2 Total Failure (P. falciparum) Day 28 PCR adjusted 2 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 2.1 Africa 2 802 Risk Ratio (M-H, Fixed, 95% CI) 0.30 [0.17, 0.54] 3 Total Failure (P. falciparum) Day 42 PCR unadjusted 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 3.1 Africa 1 341 Risk Ratio (M-H, Fixed, 95% CI) 0.64 [0.33, 1.24] 4 Total Failure (P. falciparum) Day 42 PCR adjusted 1 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 4.1 Africa 1 319 Risk Ratio (M-H, Fixed, 95% CI) 0.55 [0.16, 1.83] 5 Gametocyte development 1 367 Risk Ratio (M-H, Fixed, 95% CI) 0.70 [0.27, 1.79] 6 Anaemia 2 Mean Difference (IV, Fixed, 95% CI) Subtotals only 6.1 Mean haemoglobin (g/dl) at baseline 1 371 Mean Difference (IV, Fixed, 95% CI) -0.20 [-0.68, 0.28] 6.2 Mean haemoglobin (g/dl) at day 42 or last day of follow up 1 371 Mean Difference (IV, Fixed, 95% CI) -0.20 [-0.51, 0.11] 6.3 Mean packed cell volume at baseline 1 510 Mean Difference (IV, Fixed, 95% CI) Not estimable 6.4 Mean packed cell volume at day 14 1 510 Mean Difference (IV, Fixed, 95% CI) -1.10 [-1.73, -0.47] 7 Early vomiting 1 383 Risk Ratio (M-H, Fixed, 95% CI) 3.34 [0.70, 15.87] Comparison 6. Artesunate plus mefloquine vs Artemether-lumefantrine Outcome or subgroup title No. of studies No. of participants Statistical method Effect size 1 Total Failure (P. falciparum) Day 42 PCR unadjusted 4 Risk Ratio (M-H, Random, 95% CI) Subtotals only 1.1 Asia 4 1000 Risk Ratio (M-H, Random, 95% CI) 0.53 [0.29, 0.94] 2 Total Failure (P. falciparum) Day 42 PCR adjusted 4 Risk Ratio (M-H, Random, 95% CI) Subtotals only 2.1 Asia 4 904 Risk Ratio (M-H, Random, 95% CI) 0.38 [0.05, 2.84] 3 Total Failure (P. falciparum) Day 28 PCR unadjusted 5 Risk Ratio (M-H, Fixed, 95% CI) Subtotals only 3.1 Africa 2 752 Risk Ratio (M-H, Fixed, 95% CI) 0.65 [0.48, 0.89] 3.2 Asia 3 854 Risk Ratio (M-H, Fixed, 95% CI) 0.80 [0.41, 1.58] 4 Total Failure (P. falciparum) Day 28 PCR adjusted 5 1479 Risk Ratio (M-H, Fixed, 95% CI) 1.25 [0.63, 2.50] 4.1 Africa 2 643 Risk Ratio (M-H, Fixed, 95% CI) 1.08 [0.41, 2.85] Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 113
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Artemisinin-based combination thera
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Analysis 2.2. Comparison 2 Dihydroa
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Analysis 10.5. Comparison 10 Arteme
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[Intervention Review] Artemisinin-b
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B A C K G R O U N D Malaria is a di
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drugs and the treatment comparisons
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this analysis into participants who
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Figure 1. Methodological quality su
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confidence intervals of the estimat
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Anaemia Hasugian 2005 IDN found tha
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Three trials report significantly m
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or those treated for P. vivax at ba
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Early vomiting Not reported. D I S
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Figure 4. Olliaro-Vaillant plot. Da
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Figure 10. Olliaro-Vaillant plot. D
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of findings tables’. For these ta
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Huambo and Bie provinces, central A
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References to studies excluded from
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Adjuik 2004 Adjuik M, Babiker A, Ga
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C H A R A C T E R I S T I C S O F S
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Ashley 2003a THA (Continued) Outcom
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Ashley 2003b THA (Continued) Alloca
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Ashley 2005 THA (Continued) Exclusi
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Bonnet 2004 GIN (Continued) Item Au
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Bukirwa 2005 UGA Methods Trial desi
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Djimde 2004 MLI (Continued) • AS
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Dorsey 2006 UGA (Continued) Item Au
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Fanello 2004 RWA Methods Trial desi
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Faye 2003 SEN (Continued) Outcomes
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Grande 2005 PER (Continued) Allocat
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Guthmann 2004 AGO (Continued) All d
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Analysis 7.2. Comparison 7 Artesuna
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Analysis 8.2. Comparison 8 Artesuna
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Analysis 9.2. Comparison 9 Artemeth
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(... Continued) Study or subgroup A
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Analysis 9.8. Comparison 9 Artemeth
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Analysis 12.2. Comparison 12 Artesu
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Analysis 14.2. Comparison 14 Dihydr
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(... Continued) Study or subgroup D
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Analysis 20.1. Comparison 20 How do
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Analysis 21.1. Comparison 21 How do
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(Continued) 2. How does artesunate
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(Continued) Sensitivity analysis 1
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(Continued) Smithuis 2004 MMR (652
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Dihydroartemisinin-piperaquine vs A
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(Continued) Mayxay 2003 LAO (220 pa
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Artesunate plus mefloquine vs Amodi
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(Continued) Faye 2003 SEN (509 part
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Artemether-lumefantrine vs Artesuna
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(Continued) Zongo 2005 BFA (521 par
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(Continued) Faye 2003 SEN (521 part
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PCR = polymerase chain reaction PCV
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(Continued) Proportion with anaemia
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(Continued) Vivax efficacy: P. viva
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(Continued) Efficacy: Total Failure
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(Continued) Outcomes Illustrative c
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(Continued) GRADE Working Group gra
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Footnotes 1 Data were also availabl
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8 Very serious imprecision: There w
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(Continued) justed Vivax efficacy:
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(Continued) Harms: Serious adverse
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(Continued) Harms: Early vomiting -
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1 Dorsey 2006 UGA; Faye 2003 SEN; K
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