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

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Analysis 10.7. Comparison 10 Artemether-lumefantrine vs Artesunate plus sulfadoxine-pyrimethamine, Outcome 7 Sensitivity analysis: Total Failure Day 28 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 10 Artemether-lumefantrine vs Artesunate plus sulfadoxine-pyrimethamine Outcome: 7 Sensitivity analysis: Total Failure Day 28 PCR adjusted Study or subgroup AL6 AS+SP Risk Ratio Weight 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 Mukhtar 2005 SDN 7/79 7/72 40.2 % 0.91 [ 0.34, 2.47 ] Karunajeewa 2007 PNG 3/96 11/98 59.8 % 0.28 [ 0.08, 0.97 ] Subtotal (95% CI) 175 170 100.0 % 0.53 [ 0.25, 1.13 ] Total events: 10 (AL6), 18 (AS+SP) Heterogeneity: Chi 2 = 2.16, df = 1 (P = 0.14); I 2 =54% Test for overall effect: Z = 1.64 (P = 0.10) 2 Total Failure Day 28 PCR adjusted (trials with baseline differences included) Bousema 2004 KEN 1/73 11/142 22.0 % 0.18 [ 0.02, 1.34 ] Van den Broek 2004 ZAR 0/87 7/71 24.3 % 0.05 [ 0.00, 0.94 ] Mukhtar 2005 SDN 7/79 7/72 21.6 % 0.91 [ 0.34, 2.47 ] Karunajeewa 2007 PNG 3/96 11/98 32.1 % 0.28 [ 0.08, 0.97 ] Subtotal (95% CI) 335 383 100.0 % 0.34 [ 0.17, 0.66 ] Total events: 11 (AL6), 36 (AS+SP) Heterogeneity: Chi 2 = 5.86, df = 3 (P = 0.12); I 2 =49% Test for overall effect: Z = 3.21 (P = 0.0013) 3 Total Failure Day 28 PCR adjusted (indeterminate PCR included as failures) Mukhtar 2005 SDN 7/79 7/72 36.3 % 0.91 [ 0.34, 2.47 ] Karunajeewa 2007 PNG 5/98 13/100 63.7 % 0.39 [ 0.15, 1.06 ] Subtotal (95% CI) 177 172 100.0 % 0.58 [ 0.29, 1.16 ] Total events: 12 (AL6), 20 (AS+SP) Heterogeneity: Chi 2 = 1.38, df = 1 (P = 0.24); I 2 =28% Test for overall effect: Z = 1.54 (P = 0.12) 4 Total Failure Day 28 PCR adjusted (new infections included as successes) Mukhtar 2005 SDN 7/80 7/77 35.3 % 0.96 [ 0.35, 2.62 ] Karunajeewa 2007 PNG 5/113 13/112 64.7 % 0.38 [ 0.14, 1.03 ] Subtotal (95% CI) 193 189 100.0 % 0.59 [ 0.29, 1.17 ] Total events: 12 (AL6), 20 (AS+SP) Heterogeneity: Chi 2 = 1.66, df = 1 (P = 0.20); I 2 =40% Test for overall effect: Z = 1.52 (P = 0.13) 5 Total Failure Day 28 PCR adjusted (losses to follow up included as failures) 0.005 0.1 1 10 200 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. (Continued ...) 182
(... Continued) Study or subgroup AL6 AS+SP Risk Ratio Weight Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Mukhtar 2005 SDN 7/80 10/80 29.9 % 0.70 [ 0.28, 1.75 ] Karunajeewa 2007 PNG 19/127 23/122 70.1 % 0.79 [ 0.46, 1.38 ] Subtotal (95% CI) 207 202 100.0 % 0.77 [ 0.48, 1.23 ] Total events: 26 (AL6), 33 (AS+SP) Heterogeneity: Chi 2 = 0.05, df = 1 (P = 0.82); I 2 =0.0% Test for overall effect: Z = 1.10 (P = 0.27) 6 Total Failure Day 28 PCR adjusted (losses to follow up included as successes) Mukhtar 2005 SDN 7/80 7/80 34.5 % 1.00 [ 0.37, 2.72 ] Karunajeewa 2007 PNG 5/127 13/122 65.5 % 0.37 [ 0.14, 1.01 ] Subtotal (95% CI) 207 202 100.0 % 0.59 [ 0.30, 1.17 ] Total events: 12 (AL6), 20 (AS+SP) Heterogeneity: Chi 2 = 1.91, df = 1 (P = 0.17); I 2 =48% Test for overall effect: Z = 1.52 (P = 0.13) 0.005 0.1 1 10 200 Favours AL6 Favours AS+SP Analysis 11.1. Comparison 11 Artemether-lumefantrine vs Amodiaquine plus sulfadoxine-pyrimethamine, Outcome 1 Total Failure (P. falciparum) Day 28 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 11 Artemether-lumefantrine vs Amodiaquine plus sulfadoxine-pyrimethamine Outcome: 1 Total Failure (P. falciparum) Day 28 PCR unadjusted Study or subgroup AL6 AQ+SP Risk Ratio Weight Risk Ratio 1 East Africa n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Fanello 2004 RWA 36/246 89/247 22.1 % 0.41 [ 0.29, 0.57 ] Mutabingwa 2004 TZA 103/485 282/463 71.8 % 0.35 [ 0.29, 0.42 ] Dorsey 2006 UGA 5/100 25/105 6.1 % 0.21 [ 0.08, 0.53 ] Subtotal (95% CI) 831 815 100.0 % 0.35 [ 0.30, 0.41 ] Total events: 144 (AL6), 396 (AQ+SP) Heterogeneity: Chi 2 = 1.88, df = 2 (P = 0.39); I 2 =0.0% Test for overall effect: Z = 12.61 (P < 0.00001) 2 West Africa 0.01 0.1 1 10 100 Favours AL6 Favours AQ+SP Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued ...) 183
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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 137 and 138: (... Continued) Study or subgroup D
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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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