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

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Analysis 6.2. Comparison 6 Artesunate plus mefloquine vs Artemether-lumefantrine, Outcome 2 Total Failure (P. falciparum) Day 42 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 6 Artesunate plus mefloquine vs Artemether-lumefantrine Outcome: 2 Total Failure (P. falciparum) Day 42 PCR adjusted 1 Asia Study or subgroup AS+MQ AL6 Risk Ratio Weight Risk Ratio n/N n/N M-H,Random,95% CI M-H,Random,95% CI Hutagalung 2002 THA 9/212 3/201 34.7 % 2.84 [ 0.78, 10.36 ] Van den Broek 2003a BGD 0/105 3/102 21.7 % 0.14 [ 0.01, 2.65 ] Stohrer 2003 LAO 0/45 3/37 21.9 % 0.12 [ 0.01, 2.21 ] Mayxay 2003 LAO 0/106 3/96 21.7 % 0.13 [ 0.01, 2.48 ] 0.005 0.1 1 10 200 Favours ASMQ Favours AL Analysis 6.3. Comparison 6 Artesunate plus mefloquine vs Artemether-lumefantrine, Outcome 3 Total Failure (P. falciparum) Day 28 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 6 Artesunate plus mefloquine vs Artemether-lumefantrine Outcome: 3 Total Failure (P. falciparum) Day 28 PCR unadjusted Study or subgroup AS+MQ AL6 Risk Ratio Weight Risk Ratio 1 Africa n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Faye 2003 SEN 2/144 0/147 0.6 % 5.10 [ 0.25, 105.39 ] Sagara 2005b MLI 47/230 76/231 99.4 % 0.62 [ 0.45, 0.85 ] Subtotal (95% CI) 374 378 100.0 % 0.65 [ 0.48, 0.89 ] Total events: 49 (AS+MQ), 76 (AL6) Heterogeneity: Chi 2 = 1.86, df = 1 (P = 0.17); I 2 =46% Test for overall effect: Z = 2.72 (P = 0.0066) 2 Asia Van Vugt 1998 THA 0/47 4/134 12.3 % 0.31 [ 0.02, 5.70 ] 0.005 0.1 1 10 200 Favours ASMQ Favours AL Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued ...) 156
(... Continued) Study or subgroup AS+MQ AL6 Risk Ratio Weight Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Lefevre 1999 THA 0/53 7/155 20.0 % 0.19 [ 0.01, 3.32 ] Hutagalung 2002 THA 14/233 13/232 67.7 % 1.07 [ 0.52, 2.23 ] Subtotal (95% CI) 333 521 100.0 % 0.80 [ 0.41, 1.58 ] Total events: 14 (AS+MQ), 24 (AL6) Heterogeneity: Chi 2 = 1.97, df = 2 (P = 0.37); I 2 =0.0% Test for overall effect: Z = 0.64 (P = 0.52) 0.005 0.1 1 10 200 Favours ASMQ Favours AL Analysis 6.4. Comparison 6 Artesunate plus mefloquine vs Artemether-lumefantrine, Outcome 4 Total Failure (P. falciparum) Day 28 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 6 Artesunate plus mefloquine vs Artemether-lumefantrine Outcome: 4 Total Failure (P. falciparum) Day 28 PCR adjusted Study or subgroup AS+MQ AL6 Risk Ratio Risk Ratio 1 Africa n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Faye 2003 SEN 0/142 0/147 0.0 [ 0.0, 0.0 ] Sagara 2005b MLI 9/192 7/162 1.08 [ 0.41, 2.85 ] Subtotal (95% CI) 334 309 1.08 [ 0.41, 2.85 ] Total events: 9 (AS+MQ), 7 (AL6) Heterogeneity: Chi 2 = 0.0, df = 0 (P = 1.00); I 2 =0.0% Test for overall effect: Z = 0.17 (P = 0.87) 2 Asia Van Vugt 1998 THA 0/47 3/133 0.40 [ 0.02, 7.58 ] Lefevre 1999 THA 0/53 6/154 0.22 [ 0.01, 3.85 ] Hutagalung 2002 THA 9/228 2/221 4.36 [ 0.95, 19.96 ] Subtotal (95% CI) 328 508 1.43 [ 0.53, 3.86 ] Total events: 9 (AS+MQ), 11 (AL6) Heterogeneity: Chi 2 = 4.43, df = 2 (P = 0.11); I 2 =55% Test for overall effect: Z = 0.70 (P = 0.48) Total (95% CI) 662 817 1.25 [ 0.63, 2.50 ] Total events: 18 (AS+MQ), 18 (AL6) Heterogeneity: Chi 2 = 4.67, df = 3 (P = 0.20); I 2 =36% Test for overall effect: Z = 0.64 (P = 0.52) Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.005 0.1 1 10 200 Favours ASMQ Favours AL 157
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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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Stohrer 2003 LAO Methods Trial desi
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Swarthout 2004 ZAR (Continued) Note
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Tran 2002 VNM Methods Trial design:
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Van den Broek 2003a BGD (Continued)
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Van Vugt 1998 THA Methods Trial des
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Yeka 2004 UGA (Continued) Risk of b
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Yeka 2007 UGA (Continued) Free of o
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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
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Analysis 15.6. Comparison 15 Dihydr
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Analysis 17.1. Comparison 17 Artesu
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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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