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

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Analysis 1.11. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 11 Early vomiting. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 11 Early vomiting 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 Janssens 2003 KHM 56/228 67/236 0.87 [ 0.64, 1.17 ] Ashley 2003a THA 0/67 0/67 0.0 [ 0.0, 0.0 ] Ashley 2003b THA 9/179 5/177 1.78 [ 0.61, 5.21 ] Smithuis 2004 MMR 8/156 10/162 0.83 [ 0.34, 2.05 ] Ashley 2004 THA 8/333 6/166 0.66 [ 0.23, 1.88 ] Grande 2005 PER 10/262 11/260 0.90 [ 0.39, 2.09 ] Tangpukdee 2005 THA 0/120 0/60 0.0 [ 0.0, 0.0 ] Total (95% CI) 1345 1128 0.90 [ 0.69, 1.16 ] Total events: 91 (DHA-P), 99 (AS+MQ) Heterogeneity: Chi 2 = 1.96, df = 4 (P = 0.74); I 2 =0.0% Test for overall effect: Z = 0.84 (P = 0.40) Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.2 0.5 1 2 5 Favours DHA-P Favours AS+MQ 132
Analysis 1.12. Comparison 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine, Outcome 12 Sensitivity analysis: Total Failure Day 63 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 1 Dihydroartemisinin-piperaquine vs Artesunate plus mefloquine Outcome: 12 Sensitivity analysis: Total Failure Day 63 PCR unadjusted Study or subgroup DHA-P AS+MQ Risk Ratio Weight Risk Ratio 1 Total Failure (P. falciparum) Day 63 PCR unadjusted n/N n/N M-H,Random,95% CI M-H,Random,95% CI Ashley 2003b THA 26/154 29/151 32.2 % 0.88 [ 0.54, 1.42 ] Janssens 2003 KHM 18/195 22/207 27.5 % 0.87 [ 0.48, 1.57 ] Ashley 2004 THA 29/318 27/157 31.8 % 0.53 [ 0.33, 0.86 ] Grande 2005 PER 12/219 2/226 8.5 % 6.19 [ 1.40, 27.35 ] Subtotal (95% CI) 886 741 100.0 % 0.94 [ 0.52, 1.70 ] Total events: 85 (DHA-P), 80 (AS+MQ) Heterogeneity: Tau 2 = 0.24; Chi 2 = 10.50, df = 3 (P = 0.01); I 2 =71% Test for overall effect: Z = 0.21 (P = 0.83) 2 Total Failure Day 63 PCR unadjusted (losses to follow up included as failures) Ashley 2003b THA 51/179 54/176 27.1 % 0.93 [ 0.67, 1.28 ] Janssens 2003 KHM 38/215 45/230 25.0 % 0.90 [ 0.61, 1.33 ] Ashley 2004 THA 43/332 36/166 24.6 % 0.60 [ 0.40, 0.89 ] Grande 2005 PER 45/252 27/251 23.3 % 1.66 [ 1.06, 2.59 ] Subtotal (95% CI) 978 823 100.0 % 0.95 [ 0.65, 1.38 ] Total events: 177 (DHA-P), 162 (AS+MQ) Heterogeneity: Tau 2 = 0.11; Chi 2 = 11.26, df = 3 (P = 0.01); I 2 =73% Test for overall effect: Z = 0.29 (P = 0.77) 3 Total Failure Day 63 PCR unadjusted (losses to follow up included as successes) Ashley 2003b THA 26/179 29/176 32.0 % 0.88 [ 0.54, 1.43 ] Janssens 2003 KHM 18/215 22/230 27.6 % 0.88 [ 0.48, 1.59 ] Ashley 2004 THA 29/332 27/166 31.9 % 0.54 [ 0.33, 0.88 ] Grande 2005 PER 12/252 2/251 8.5 % 5.98 [ 1.35, 26.43 ] Subtotal (95% CI) 978 823 100.0 % 0.94 [ 0.52, 1.68 ] Total events: 85 (DHA-P), 80 (AS+MQ) Heterogeneity: Tau 2 = 0.23; Chi 2 = 10.06, df = 3 (P = 0.02); I 2 =70% Test for overall effect: Z = 0.22 (P = 0.82) 0.05 0.2 1 5 20 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. 133
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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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Martensson 2003 TZA Methods Trial d
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Mayxay 2003 LAO (Continued) 1. Feve
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Menard 2006 MDG Methods Trial desig
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Page 113 and 114: (Continued) Fofana 2005 Conference
Page 115 and 116: D A T A A N D A N A L Y S E S Compa
Page 117 and 118: 2.2 Asia 1 317 Risk Ratio (M-H, Fix
Page 119 and 120: Comparison 5. Dihydroartemisinin-pi
Page 121 and 122: Comparison 8. Artesunate plus meflo
Page 123 and 124: Comparison 10. Artemether-lumefantr
Page 125 and 126: Comparison 12. Artesunate plus amod
Page 127 and 128: 5.2 DHA-P 3 doses 3 1116 Risk Ratio
Page 129 and 130: Comparison 21. How does Artesunate
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Page 165 and 166: Analysis 6.6. Comparison 6 Artesuna
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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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