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

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Analysis 2.1. Comparison 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine, Outcome 1 Total Failure (P. falciparum) Day 42 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine Outcome: 1 Total Failure (P. falciparum) Day 42 PCR unadjusted 1 Africa Study or subgroup DHA-P AL6 Risk Ratio Weight Risk Ratio n/N n/N M-H,Random,95% CI M-H,Random,95% CI Kamya 2006 UGA 90/207 108/197 38.4 % 0.79 [ 0.65, 0.97 ] Zongo 2007 BFA 13/172 55/176 29.5 % 0.24 [ 0.14, 0.43 ] Yeka 2007 UGA 21/207 46/177 32.0 % 0.39 [ 0.24, 0.63 ] Subtotal (95% CI) 586 550 100.0 % 0.44 [ 0.20, 0.95 ] Total events: 124 (DHA-P), 209 (AL6) Heterogeneity: Tau 2 = 0.42; Chi 2 = 22.19, df = 2 (P = 0.00002); I 2 =91% Test for overall effect: Z = 2.10 (P = 0.036) 2 Asia Ratcliff 2005 IDN 19/195 26/161 100.0 % 0.60 [ 0.35, 1.05 ] Subtotal (95% CI) 195 161 100.0 % 0.60 [ 0.35, 1.05 ] Total events: 19 (DHA-P), 26 (AL6) Heterogeneity: not applicable Test for overall effect: Z = 1.79 (P = 0.074) 3 Oceania Karunajeewa 2007 PNG 42/107 40/109 100.0 % 1.07 [ 0.76, 1.50 ] Subtotal (95% CI) 107 109 100.0 % 1.07 [ 0.76, 1.50 ] Total events: 42 (DHA-P), 40 (AL6) Heterogeneity: not applicable Test for overall effect: Z = 0.39 (P = 0.70) 0.01 0.1 1 10 100 Favours DHA-P Favours AL6 Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 136
Analysis 2.2. Comparison 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine, Outcome 2 Total Failure (P. falciparum) Day 42 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine Outcome: 2 Total Failure (P. falciparum) Day 42 PCR adjusted 1 Africa Study or subgroup DHA-P AL6 Risk Ratio Weight Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Kamya 2006 UGA 13/130 28/117 60.4 % 0.42 [ 0.23, 0.77 ] Yeka 2007 UGA 4/190 10/141 23.5 % 0.30 [ 0.10, 0.93 ] Zongo 2007 BFA 4/163 7/128 16.1 % 0.45 [ 0.13, 1.50 ] Subtotal (95% CI) 483 386 100.0 % 0.39 [ 0.24, 0.64 ] Total events: 21 (DHA-P), 45 (AL6) Heterogeneity: Chi 2 = 0.32, df = 2 (P = 0.85); I 2 =0.0% Test for overall effect: Z = 3.72 (P = 0.00020) 2 Asia Ratcliff 2005 IDN 3/179 3/138 100.0 % 0.77 [ 0.16, 3.76 ] Subtotal (95% CI) 179 138 100.0 % 0.77 [ 0.16, 3.76 ] Total events: 3 (DHA-P), 3 (AL6) Heterogeneity: not applicable Test for overall effect: Z = 0.32 (P = 0.75) 3 Oceania Karunajeewa 2007 PNG 12/77 5/74 100.0 % 2.31 [ 0.85, 6.23 ] Subtotal (95% CI) 77 74 100.0 % 2.31 [ 0.85, 6.23 ] Total events: 12 (DHA-P), 5 (AL6) Heterogeneity: not applicable Test for overall effect: Z = 1.65 (P = 0.099) 0.01 0.1 1 10 100 Favours DHA-P Favours AL6 Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 137
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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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Mens 2007 KEN (Continued) Risk of b
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Mutabingwa 2004 TZA (Continued) •
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(... Continued) Study or subgroup A
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Analysis 11.9. Comparison 11 Arteme
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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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