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

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Analysis 2.7. Comparison 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine, Outcome 7 Anaemia. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine Outcome: 7 Anaemia Study or subgroup DHA-P AL6 Mean Difference Weight Mean Difference 1 Mean haemoglobin (g/dl) at baseline N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI Kamya 2006 UGA 211 9.5 (1.9) 210 9.7 (1.8) 31.3 % -0.20 [ -0.55, 0.15 ] Zongo 2007 BFA 187 10.1 (2.4) 188 10.2 (2) 19.6 % -0.10 [ -0.55, 0.35 ] Mens 2007 KEN 73 6.33 (1.29) 73 6.28 (1.27) 22.7 % 0.05 [ -0.37, 0.47 ] Yeka 2007 UGA 215 9.9 (2.1) 199 9.9 (1.9) 26.4 % 0.0 [ -0.39, 0.39 ] Subtotal (95% CI) 686 670 100.0 % -0.07 [ -0.27, 0.13 ] Heterogeneity: Chi 2 = 0.98, df = 3 (P = 0.81); I 2 =0.0% Test for overall effect: Z = 0.70 (P = 0.48) 2 Mean haemoglobin (g/dl) at day 28 Mens 2007 KEN 67 7.15 (1.07) 67 6.79 (1.24) 100.0 % 0.36 [ -0.03, 0.75 ] Subtotal (95% CI) 67 67 100.0 % 0.36 [ -0.03, 0.75 ] Heterogeneity: not applicable Test for overall effect: Z = 1.80 (P = 0.072) 3 Mean haemoglobin (g/dl) at day 42 Zongo 2007 BFA 187 11.6 (1.6) 188 11.3 (1.6) 100.0 % 0.30 [ -0.02, 0.62 ] Subtotal (95% CI) 187 188 100.0 % 0.30 [ -0.02, 0.62 ] Heterogeneity: not applicable Test for overall effect: Z = 1.82 (P = 0.069) 4 Mean change in haemoglobin (g/dl) from baseline to Day 42 Kamya 2006 UGA 211 1.9 (1.8) 210 1.5 (1.8) 53.3 % 0.40 [ 0.06, 0.74 ] Yeka 2007 UGA 215 1.75 (1.8) 199 1.66 (2) 46.7 % 0.09 [ -0.28, 0.46 ] Subtotal (95% CI) 426 409 100.0 % 0.26 [ 0.00, 0.51 ] Heterogeneity: Chi 2 = 1.46, df = 1 (P = 0.23); I 2 =31% Test for overall effect: Z = 1.99 (P = 0.046) Test for subgroup differences: Chi 2 = 7.29, df = 3 (P = 0.06), I 2 =59% Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. -0.5 -0.25 0 0.25 0.5 Favours AL6 Favours DHA-P 142
Analysis 2.8. Comparison 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine, Outcome 8 Serious adverse events (including deaths). Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine Outcome: 8 Serious adverse events (including deaths) Study or subgroup DHA-P AL6 Risk Ratio Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Ratcliff 2005 IDN 1/379 2/375 0.49 [ 0.05, 5.43 ] Kamya 2006 UGA 4/211 2/210 1.99 [ 0.37, 10.75 ] Yeka 2007 UGA 5/215 2/199 2.31 [ 0.45, 11.79 ] Zongo 2007 BFA 0/187 0/188 0.0 [ 0.0, 0.0 ] Mens 2007 KEN 1/73 0/73 3.00 [ 0.12, 72.45 ] Total (95% CI) 1065 1045 1.71 [ 0.66, 4.46 ] Total events: 11 (DHA-P), 6 (AL6) Heterogeneity: Chi 2 = 1.31, df = 3 (P = 0.73); I 2 =0.0% Test for overall effect: Z = 1.10 (P = 0.27) 0.01 0.1 1 10 100 Favours DHA-P Favours AL6 Analysis 2.9. Comparison 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine, Outcome 9 Early vomiting. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 2 Dihydroartemisinin-piperaquine vs Artemether-lumefantrine Outcome: 9 Early vomiting 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 Ratcliff 2005 IDN 11/379 10/375 77.1 % 1.09 [ 0.47, 2.53 ] Zongo 2007 BFA 7/196 3/197 22.9 % 2.35 [ 0.62, 8.94 ] Total (95% CI) 575 572 100.0 % 1.38 [ 0.68, 2.78 ] Total events: 18 (DHA-P), 13 (AL6) Heterogeneity: Chi 2 = 0.91, df = 1 (P = 0.34); I 2 =0.0% Test for overall effect: Z = 0.89 (P = 0.37) 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. 143
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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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Owusu-Agyei 2006 GHA (Continued) Fr
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Sagara 2005b MLI (Continued) • 25
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Smithuis 2004 MMR (Continued) Risk
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Page 127 and 128: 5.2 DHA-P 3 doses 3 1116 Risk Ratio
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Page 165 and 166: Analysis 6.6. Comparison 6 Artesuna
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Analysis 12.4. 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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