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

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Analysis 9.10. Comparison 9 Artemether-lumefantrine vs Artesunate plus amodiaquine, Outcome 10 Sensitivity analysis: Total Failure Day 28 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 9 Artemether-lumefantrine vs Artesunate plus amodiaquine Outcome: 10 Sensitivity analysis: Total Failure Day 28 PCR adjusted Study or subgroup AL6 AS+AQ Risk Ratio Risk Ratio 1 Total Failure (P. falciparum) Day 28 PCR adjusted n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Faye 2003 SEN 0/147 0/340 0.0 [ 0.0, 0.0 ] Guthmann 2004 AGO 0/59 0/60 0.0 [ 0.0, 0.0 ] Falade 2005 NGA 0/59 0/56 0.0 [ 0.0, 0.0 ] Bukirwa 2005 UGA 2/102 0/68 3.35 [ 0.16, 68.71 ] Owusu-Agyei 2006 GHA 12/122 7/136 1.91 [ 0.78, 4.70 ] Dorsey 2006 UGA 0/95 2/100 0.21 [ 0.01, 4.33 ] Adjei 2006 GHA 4/101 2/104 2.06 [ 0.39, 11.00 ] Kobbe 2007 GHA 12/92 7/88 1.64 [ 0.68, 3.97 ] Subtotal (95% CI) 777 952 1.65 [ 0.95, 2.87 ] Total events: 30 (AL6), 18 (AS+AQ) Heterogeneity: Chi 2 = 2.16, df = 4 (P = 0.71); I 2 =0.0% Test for overall effect: Z = 1.77 (P = 0.077) 2 Total Failure Day 28 PCR adjusted (trials with baseline differences included) Faye 2003 SEN 0/147 0/340 0.0 [ 0.0, 0.0 ] Martensson 2003 TZA 5/188 13/162 0.33 [ 0.12, 0.91 ] Koram 2003 GHA 1/40 0/38 2.85 [ 0.12, 67.97 ] Guthmann 2004 AGO 0/59 0/60 0.0 [ 0.0, 0.0 ] Van den Broek 2004 ZAR 0/87 1/67 0.26 [ 0.01, 6.22 ] Bukirwa 2005 UGA 2/102 0/68 3.35 [ 0.16, 68.71 ] Falade 2005 NGA 0/59 0/56 0.0 [ 0.0, 0.0 ] Adjei 2006 GHA 4/101 2/104 2.06 [ 0.39, 11.00 ] Dorsey 2006 UGA 0/95 2/100 0.21 [ 0.01, 4.33 ] Owusu-Agyei 2006 GHA 12/122 7/136 1.91 [ 0.78, 4.70 ] Kobbe 2007 GHA 12/92 7/88 1.64 [ 0.68, 3.97 ] Subtotal (95% CI) 1092 1219 1.07 [ 0.69, 1.67 ] Total events: 36 (AL6), 32 (AS+AQ) Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.001 0.01 0.1 1 10 100 1000 Favours AL6 Favours AS+AQ (Continued ...) 174
(... Continued) Study or subgroup AL6 AS+AQ Risk Ratio Risk Ratio Heterogeneity: Chi 2 = 11.04, df = 7 (P = 0.14); I 2 =37% Test for overall effect: Z = 0.31 (P = 0.76) 3 Total Failure Day 28 PCR adjusted (indeterminate PCR included as failures) n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Faye 2003 SEN 0/147 0/340 0.0 [ 0.0, 0.0 ] Guthmann 2004 AGO 0/59 0/60 0.0 [ 0.0, 0.0 ] Falade 2005 NGA 0/59 0/56 0.0 [ 0.0, 0.0 ] Bukirwa 2005 UGA 5/105 1/69 3.29 [ 0.39, 27.52 ] Dorsey 2006 UGA 0/95 3/101 0.15 [ 0.01, 2.90 ] Owusu-Agyei 2006 GHA 21/131 10/139 2.23 [ 1.09, 4.55 ] Adjei 2006 GHA 4/101 2/104 2.06 [ 0.39, 11.00 ] Kobbe 2007 GHA 12/92 8/89 1.45 [ 0.62, 3.38 ] Subtotal (95% CI) 789 958 1.72 [ 1.06, 2.78 ] Total events: 42 (AL6), 24 (AS+AQ) Heterogeneity: Chi 2 = 3.66, df = 4 (P = 0.45); I 2 =0.0% Test for overall effect: Z = 2.22 (P = 0.027) 4 Total Failure Day 28 PCR adjusted (new infections included as successes) Faye 2003 SEN 0/147 0/349 0.0 [ 0.0, 0.0 ] Guthmann 2004 AGO 0/61 0/64 0.0 [ 0.0, 0.0 ] Falade 2005 NGA 0/62 0/61 0.0 [ 0.0, 0.0 ] Bukirwa 2005 UGA 5/202 1/201 4.98 [ 0.59, 42.21 ] Dorsey 2006 UGA 0/100 3/105 0.15 [ 0.01, 2.87 ] Adjei 2006 GHA 4/103 2/107 2.08 [ 0.39, 11.10 ] Owusu-Agyei 2006 GHA 21/152 10/151 2.09 [ 1.02, 4.28 ] Kobbe 2007 GHA 12/103 8/96 1.40 [ 0.60, 3.27 ] Subtotal (95% CI) 930 1134 1.70 [ 1.06, 2.75 ] Total events: 42 (AL6), 24 (AS+AQ) Heterogeneity: Chi 2 = 4.14, df = 4 (P = 0.39); I 2 =3% Test for overall effect: Z = 2.18 (P = 0.029) 5 Total Failure Day 28 PCR adjusted (losses to follow up included as failures) Faye 2003 SEN 2/149 11/360 0.44 [ 0.10, 1.96 ] Guthmann 2004 AGO 4/65 5/69 0.85 [ 0.24, 3.03 ] Falade 2005 NGA 4/66 5/66 0.80 [ 0.22, 2.85 ] Bukirwa 2005 UGA 7/204 4/204 1.75 [ 0.52, 5.89 ] Adjei 2006 GHA 12/111 11/116 1.14 [ 0.52, 2.48 ] Owusu-Agyei 2006 GHA 46/177 37/178 1.25 [ 0.86, 1.83 ] Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.001 0.01 0.1 1 10 100 1000 Favours AL6 Favours AS+AQ (Continued ...) 175
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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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Zongo 2007 BFA (Continued) Novartis
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(Continued) Fofana 2005 Conference
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D A T A A N D A N A L Y S E S Compa
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2.2 Asia 1 317 Risk Ratio (M-H, Fix
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Comparison 5. Dihydroartemisinin-pi
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Comparison 8. Artesunate plus meflo
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Comparison 10. Artemether-lumefantr
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Comparison 12. Artesunate plus amod
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5.2 DHA-P 3 doses 3 1116 Risk Ratio
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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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