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

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Analysis 1.5. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 5 Total Failure (P. falciparum) Day 28 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 5 Total Failure (P. falciparum) Day 28 PCR unadjusted 1 Asia Study or subgroup DHA-P AS+MQ Risk Ratio Risk Ratio n/N n/N M-H,Random,95% CI M-H,Random,95% CI Tran 2002 VNM 0/166 0/77 0.0 [ 0.0, 0.0 ] Janssens 2003 KHM 2/195 2/207 1.06 [ 0.15, 7.46 ] Ashley 2003a THA 1/59 0/59 3.00 [ 0.12, 72.18 ] Ashley 2004 THA 5/318 13/157 0.19 [ 0.07, 0.52 ] Smithuis 2004 MMR 6/319 0/316 12.88 [ 0.73, 227.64 ] Tangpukdee 2005 THA 1/107 0/54 1.53 [ 0.06, 36.89 ] 0.005 0.1 1 10 200 Favours DHA-P Favours AS+MQ Analysis 1.6. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 6 Total Failure (P. falciparum) Day 28 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 6 Total Failure (P. falciparum) Day 28 PCR adjusted 1 Asia Study or subgroup DHA-P AS+MQ Risk Ratio Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Tran 2002 VNM 0/166 0/77 0.0 [ 0.0, 0.0 ] Janssens 2003 KHM 2/195 1/206 2.11 [ 0.19, 23.11 ] Ashley 2003a THA 1/59 0/59 3.00 [ 0.12, 72.18 ] Ashley 2004 THA 2/315 7/151 0.14 [ 0.03, 0.65 ] Smithuis 2004 MMR 2/315 0/316 5.02 [ 0.24, 104.06 ] Tangpukdee 2005 THA 1/107 0/54 1.53 [ 0.06, 36.89 ] Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.002 0.1 1 10 500 Favours DHA-P Favours AS+MQ 126
Analysis 1.7. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 7 P. vivax parasitaemia. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 7 P. vivax parasitaemia Study or subgroup DHA-P AS+MQ Risk Ratio Risk Ratio 1 Mixed P. falciparum and vivax infection at baseline n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Ashley 2003b THA 13/179 19/176 0.67 [ 0.34, 1.32 ] Smithuis 2004 MMR 40/327 47/325 0.85 [ 0.57, 1.25 ] Ashley 2004 THA 31/333 16/166 0.97 [ 0.54, 1.71 ] Mayxay 2004 LAO 0/110 0/110 0.0 [ 0.0, 0.0 ] Grande 2005 PER 0/262 0/260 0.0 [ 0.0, 0.0 ] Subtotal (95% CI) 1211 1037 0.84 [ 0.63, 1.12 ] Total events: 84 (DHA-P), 82 (AS+MQ) Heterogeneity: Chi 2 = 0.65, df = 2 (P = 0.72); I 2 =0.0% Test for overall effect: Z = 1.19 (P = 0.23) 2 Total P. vivax parasitaemia by day 28 Janssens 2003 KHM 3/195 0/207 7.43 [ 0.39, 142.89 ] Subtotal (95% CI) 195 207 7.43 [ 0.39, 142.89 ] Total events: 3 (DHA-P), 0 (AS+MQ) Heterogeneity: not applicable Test for overall effect: Z = 1.33 (P = 0.18) 3 Total P. vivax parasitaemia by day 42 Janssens 2003 KHM 10/195 9/207 1.18 [ 0.49, 2.84 ] Smithuis 2004 MMR 40/319 57/316 0.70 [ 0.48, 1.01 ] Mayxay 2004 LAO 3/106 1/108 3.06 [ 0.32, 28.92 ] Subtotal (95% CI) 620 631 0.79 [ 0.57, 1.11 ] Total events: 53 (DHA-P), 67 (AS+MQ) Heterogeneity: Chi 2 = 2.65, df = 2 (P = 0.27); I 2 =24% Test for overall effect: Z = 1.35 (P = 0.18) 4 Total P. vivax parasitaemia by day 63 Janssens 2003 KHM 39/195 47/207 0.88 [ 0.60, 1.28 ] Ashley 2003b THA 52/156 42/152 1.21 [ 0.86, 1.69 ] Ashley 2004 THA 89/319 38/166 1.22 [ 0.88, 1.70 ] Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.01 0.1 1 10 100 Favours DHA-P Favours AS+MQ (Continued ...) 127
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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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Koram 2003 GHA (Continued) Adequate
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(... Continued) Study or subgroup A
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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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