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

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Analysis 10.5. Comparison 10 Artemether-lumefantrine vs Artesunate plus sulfadoxine-pyrimethamine, Outcome 5 P. vivax parasitaemia. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 10 Artemether-lumefantrine vs Artesunate plus sulfadoxine-pyrimethamine Outcome: 5 P. vivax parasitaemia Study or subgroup AL6 AS+SP Risk Ratio Weight Risk Ratio 1 P. vivax parasitaemia by day 42 (P. vivax P. falciparum at baseline) n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Karunajeewa 2007 PNG 23/33 26/39 100.0 % 1.05 [ 0.76, 1.43 ] Subtotal (95% CI) 33 39 100.0 % 1.05 [ 0.76, 1.43 ] Total events: 23 (AL6), 26 (AS+SP) Heterogeneity: not applicable Test for overall effect: Z = 0.28 (P = 0.78) 2 P. vivax parasitaemia by day 42 (P. falciparum mono-infection at baseline) Karunajeewa 2007 PNG 66/102 56/94 100.0 % 1.09 [ 0.87, 1.35 ] Subtotal (95% CI) 102 94 100.0 % 1.09 [ 0.87, 1.35 ] Total events: 66 (AL6), 56 (AS+SP) Heterogeneity: not applicable Test for overall effect: Z = 0.74 (P = 0.46) 0.01 0.1 1 10 100 Favours AL6 Favours AS+SP Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 180
Analysis 10.6. Comparison 10 Artemether-lumefantrine vs Artesunate plus sulfadoxine-pyrimethamine, Outcome 6 Sensitivity analysis Total Failure Day 28 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 10 Artemether-lumefantrine vs Artesunate plus sulfadoxine-pyrimethamine Outcome: 6 Sensitivity analysis Total Failure Day 28 PCR unadjusted Study or subgroup AL6 AS+SP Risk Ratio Weight Risk Ratio 1 Total Failure (P. falciparum) Day 28 PCR unadjusted n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Mukhtar 2005 SDN 8/80 12/77 32.8 % 0.64 [ 0.28, 1.48 ] Karunajeewa 2007 PNG 20/113 25/112 67.2 % 0.79 [ 0.47, 1.34 ] Subtotal (95% CI) 193 189 100.0 % 0.74 [ 0.48, 1.16 ] Total events: 28 (AL6), 37 (AS+SP) Heterogeneity: Chi 2 = 0.18, df = 1 (P = 0.67); I 2 =0.0% Test for overall effect: Z = 1.30 (P = 0.19) 2 Total Failure Day 28 PCR unadjusted (trials with baseline differences included) Bousema 2004 KEN 3/75 29/160 23.6 % 0.22 [ 0.07, 0.70 ] Van den Broek 2004 ZAR 13/100 21/85 28.9 % 0.53 [ 0.28, 0.99 ] Mukhtar 2005 SDN 8/80 12/77 15.6 % 0.64 [ 0.28, 1.48 ] Karunajeewa 2007 PNG 20/113 25/112 32.0 % 0.79 [ 0.47, 1.34 ] Subtotal (95% CI) 368 434 100.0 % 0.56 [ 0.39, 0.79 ] Total events: 44 (AL6), 87 (AS+SP) Heterogeneity: Chi 2 = 4.33, df = 3 (P = 0.23); I 2 =31% Test for overall effect: Z = 3.30 (P = 0.00097) 3 Total Failure Day 28 PCR unadjusted (losses to follow up included as failures) Mukhtar 2005 SDN 8/80 15/80 29.6 % 0.53 [ 0.24, 1.19 ] Karunajeewa 2007 PNG 34/127 35/122 70.4 % 0.93 [ 0.62, 1.39 ] Subtotal (95% CI) 207 202 100.0 % 0.81 [ 0.57, 1.17 ] Total events: 42 (AL6), 50 (AS+SP) Heterogeneity: Chi 2 = 1.52, df = 1 (P = 0.22); I 2 =34% Test for overall effect: Z = 1.12 (P = 0.26) 4 Total Failure Day 28 PCR unadjusted (losses to follow up included as successes) Mukhtar 2005 SDN 8/80 12/80 32.0 % 0.67 [ 0.29, 1.54 ] Karunajeewa 2007 PNG 20/127 25/122 68.0 % 0.77 [ 0.45, 1.31 ] Subtotal (95% CI) 207 202 100.0 % 0.74 [ 0.47, 1.15 ] Total events: 28 (AL6), 37 (AS+SP) Heterogeneity: Chi 2 = 0.08, df = 1 (P = 0.78); I 2 =0.0% Test for overall effect: Z = 1.34 (P = 0.18) 0.05 0.2 1 5 20 Favours AL6 Favours AS+SP Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 181
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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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Comparison 21. How does Artesunate
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Page 135 and 136: Analysis 1.8. Comparison 1 Dihydroa
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Page 165 and 166: Analysis 6.6. Comparison 6 Artesuna
Page 173 and 174: Analysis 9.2. Comparison 9 Artemeth
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Page 197 and 198: Analysis 12.2. Comparison 12 Artesu
Page 207 and 208: Analysis 14.2. Comparison 14 Dihydr
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Page 227 and 228: (Continued) Smithuis 2004 MMR (652
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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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