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

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(... Continued) 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 Subtotal (95% CI) 219 226 100.0 % 6.19 [ 1.40, 27.35 ] Total events: 12 (DHA-P), 2 (AS+MQ) Heterogeneity: not applicable Test for overall effect: Z = 2.41 (P = 0.016) 0.01 0.1 1 10 100 Favours DHA-P Favours AS+MQ Analysis 1.2. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 2 Total Failure (P. falciparum) Day 63 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 2 Total Failure (P. falciparum) Day 63 PCR adjusted 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 3/131 9/131 38.4 % 0.33 [ 0.09, 1.20 ] Janssens 2003 KHM 4/181 5/190 20.8 % 0.84 [ 0.23, 3.08 ] Ashley 2004 THA 3/292 7/137 40.7 % 0.20 [ 0.05, 0.77 ] Subtotal (95% CI) 604 458 100.0 % 0.39 [ 0.19, 0.79 ] Total events: 10 (DHA-P), 21 (AS+MQ) Heterogeneity: Chi 2 = 2.34, df = 2 (P = 0.31); I 2 =15% Test for overall effect: Z = 2.58 (P = 0.0099) 2 South America Grande 2005 PER 4/211 0/224 100.0 % 9.55 [ 0.52, 176.35 ] Subtotal (95% CI) 211 224 100.0 % 9.55 [ 0.52, 176.35 ] Total events: 4 (DHA-P), 0 (AS+MQ) Heterogeneity: not applicable Test for overall effect: Z = 1.52 (P = 0.13) 0.005 0.1 1 10 200 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. 124
Analysis 1.3. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 3 Total Failure (P. falciparum) Day 42 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 3 Total Failure (P. falciparum) Day 42 PCR unadjusted Study or subgroup DHA-P AS+MQ Risk Ratio Weight Risk Ratio 1 Asia n/N n/N M-H,Random,95% CI M-H,Random,95% CI Tran 2002 VNM 16/166 7/77 24.2 % 1.06 [ 0.45, 2.47 ] Janssens 2003 KHM 9/195 9/207 22.9 % 1.06 [ 0.43, 2.62 ] Mayxay 2004 LAO 4/106 5/108 15.7 % 0.82 [ 0.23, 2.95 ] Smithuis 2004 MMR 6/319 1/316 7.7 % 5.94 [ 0.72, 49.09 ] Ashley 2004 THA 16/318 19/157 29.5 % 0.42 [ 0.22, 0.79 ] 0.01 0.1 1 10 100 Favours DHA-P Favours AS+MQ Analysis 1.4. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 4 Total Failure (P. falciparum) Day 42 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 4 Total Failure (P. falciparum) Day 42 PCR adjusted Study or subgroup DHA-P AS+MQ Risk Ratio Weight Risk Ratio 1 Asia n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Tran 2002 VNM 2/152 1/71 9.5 % 0.93 [ 0.09, 10.13 ] Janssens 2003 KHM 3/189 2/200 13.6 % 1.59 [ 0.27, 9.39 ] Smithuis 2004 MMR 2/315 0/315 3.5 % 5.00 [ 0.24, 103.73 ] Ashley 2004 THA 2/304 7/145 66.4 % 0.14 [ 0.03, 0.65 ] Mayxay 2004 LAO 1/103 1/104 7.0 % 1.01 [ 0.06, 15.93 ] 0.002 0.1 1 10 500 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. 125
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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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Kobbe 2007 GHA (Continued) Exclusio
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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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