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

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1.5 Day 28: DHA-P vs Amodiaquine plus sulfadoxinepyrimethamine Comparison 19. How does Artesunate plus mefloquine perform? Outcome or subgroup title 1 Effectiveness: Total Failure (P. falciparum) PCR adjusted 1.1 Day 63: AS+MQ vs Dihydroartemisininpiperaquine 1.2 Day 42: AS+MQ vs Artemether-lumefantrine 1.3 Day 28: AS+MQ vs Artesunate plus amodiaquine 1.4 Day 28: AS+MQ vs Artesunate plus sulfadoxinepyrimethamine 1.5 Day 28: AS+MQ vs Amodiaquine plus sulfadoxinepyrimethamine 2 802 Risk Ratio (M-H, Random, 95% CI) 0.32 [0.16, 0.64] No. of studies Comparison 20. How does Artemether-lumefantrine perform? Outcome or subgroup title 1 Effectiveness: Total Failure (P. falciparum) Day PCR adjusted 1.1 Day 42: AL vs Dihydroartemisininpiperaquine 1.2 Day 42: AL vs Artesunate plus mefloquine 1.3 Day 28: AL vs Artesunate plus amodiaquine 1.4 Day 42: AL vs Artesunate plus sulfadoxinepyrimethamine 1.5 Day 28: AL vs Amodiaquine plus sulfadoxinepyrimethamine No. of participants Statistical method Effect size 9 Risk Ratio (M-H, Random, 95% CI) Subtotals only 4 1497 Risk Ratio (M-H, Random, 95% CI) 1.77 [0.55, 5.72] 4 904 Risk Ratio (M-H, Random, 95% CI) 0.38 [0.05, 2.84] 1 482 Risk Ratio (M-H, Random, 95% CI) Not estimable 0 0 Risk Ratio (M-H, Random, 95% CI) Not estimable 1 296 Risk Ratio (M-H, Random, 95% CI) Not estimable No. of studies No. of participants Statistical method Effect size 19 Risk Ratio (M-H, Random, 95% CI) Subtotals only Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 5 1337 Risk Ratio (M-H, Random, 95% CI) 1.61 [0.77, 3.39] 4 904 Risk Ratio (M-H, Random, 95% CI) 2.66 [0.35, 20.09] 8 1729 Risk Ratio (M-H, Random, 95% CI) 1.71 [0.97, 3.02] 1 158 Risk Ratio (M-H, Random, 95% CI) 0.33 [0.13, 0.86] 5 1669 Risk Ratio (M-H, Random, 95% CI) 0.40 [0.08, 2.11] 122
Comparison 21. How does Artesunate plus amodiaquine perform? Outcome or subgroup title 1 Effectiveness: Total Failure (P. falciparum) PCR adjusted 1.1 Day 28: AS+AQ vs Dihydroartemisininpiperaquine 1.2 Day 28: AS+AQ vs Artesunate plus mefloquine 1.3 Day 28: AS+AQ vs Artemether-lumefantrine 1.4 Day 28: AS+AQ vs Artesunate plus sulfadoxinepyrimethamine 1.5 Day 28: AS+AQ vs Amodiaquine plus sulfadoxinepyrimethamine No. of studies No. of participants Statistical method Effect size 19 Risk Ratio (M-H, Random, 95% CI) Subtotals only 2 629 Risk Ratio (M-H, Random, 95% CI) 2.36 [0.74, 7.54] 1 482 Risk Ratio (M-H, Random, 95% CI) Not estimable 8 1729 Risk Ratio (M-H, Random, 95% CI) 0.59 [0.33, 1.03] 7 1419 Risk Ratio (M-H, Random, 95% CI) 0.70 [0.34, 1.45] 6 2364 Risk Ratio (M-H, Random, 95% CI) 0.74 [0.33, 1.63] Analysis 1.1. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 1 Total Failure (P. falciparum) Day 63 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 1 Total Failure (P. falciparum) Day 63 PCR unadjusted 1 Asia Study or subgroup DHA-P AS+MQ Risk Ratio Weight Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Ashley 2003b THA 26/154 29/151 33.7 % 0.88 [ 0.54, 1.42 ] Janssens 2003 KHM 18/195 22/207 24.6 % 0.87 [ 0.48, 1.57 ] Ashley 2004 THA 29/318 27/157 41.7 % 0.53 [ 0.33, 0.86 ] Subtotal (95% CI) 667 515 100.0 % 0.73 [ 0.54, 0.98 ] Total events: 73 (DHA-P), 78 (AS+MQ) Heterogeneity: Chi 2 = 2.56, df = 2 (P = 0.28); I 2 =22% Test for overall effect: Z = 2.09 (P = 0.037) 2 South America Grande 2005 PER 12/219 2/226 100.0 % 6.19 [ 1.40, 27.35 ] 0.01 0.1 1 10 100 Favours DHA-P Favours AS+MQ Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued ...) 123
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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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Hasugian 2005 IDN Methods Trial des
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Hutagalung 2002 THA (Continued) 5.
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Janssens 2003 KHM (Continued) Free
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Karema 2004 RWA (Continued) Interve
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Karunajeewa 2007 PNG (Continued) Ri
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(... Continued) Study or subgroup A
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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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