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

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Analysis 13.2. Comparison 13 Artesunate plus amodiaquine vs Amodiaquine plus sulfadoxinepyrimethamine, Outcome 2 Total Failure (P. falciparum) Day 28 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 13 Artesunate plus amodiaquine vs Amodiaquine plus sulfadoxine-pyrimethamine Outcome: 2 Total Failure (P. falciparum) Day 28 PCR adjusted Study or subgroup AS+AQ AQ+SP Risk Ratio Risk Ratio 1 East Africa n/N n/N M-H,Random,95% CI M-H,Random,95% CI Yeka 2004 UGA 49/405 79/465 0.71 [ 0.51, 0.99 ] Karema 2004 RWA 16/222 38/227 0.43 [ 0.25, 0.75 ] Dorsey 2006 UGA 2/100 16/96 0.12 [ 0.03, 0.51 ] Subtotal (95% CI) 727 788 0.44 [ 0.22, 0.89 ] Total events: 67 (AS+AQ), 133 (AQ+SP) Heterogeneity: Tau 2 = 0.25; Chi 2 = 7.34, df = 2 (P = 0.03); I 2 =73% Test for overall effect: Z = 2.30 (P = 0.022) 2 West Africa Faye 2003 SEN 0/340 0/154 0.0 [ 0.0, 0.0 ] Kayentao 2006 MLI 6/79 1/128 9.72 [ 1.19, 79.26 ] Subtotal (95% CI) 419 282 9.72 [ 1.19, 79.26 ] Total events: 6 (AS+AQ), 1 (AQ+SP) Heterogeneity: Tau 2 = 0.0; Chi 2 = 0.0, df = 0 (P = 1.00); I 2 =0.0% Test for overall effect: Z = 2.12 (P = 0.034) 3 Other Menard 2006 MDG 6/70 3/78 2.23 [ 0.58, 8.58 ] Subtotal (95% CI) 70 78 2.23 [ 0.58, 8.58 ] Total events: 6 (AS+AQ), 3 (AQ+SP) Heterogeneity: not applicable Test for overall effect: Z = 1.17 (P = 0.24) Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.01 0.1 1 10 100 Favours ASAQ Favours AQSP 196
Analysis 13.3. Comparison 13 Artesunate plus amodiaquine vs Amodiaquine plus sulfadoxinepyrimethamine, Outcome 3 Gametocyte development. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 13 Artesunate plus amodiaquine vs Amodiaquine plus sulfadoxine-pyrimethamine Outcome: 3 Gametocyte development Study or subgroup AS+AQ AQ+SP Risk Ratio Weight Risk Ratio n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI Staedke 2003 UGA 6/121 9/125 5.3 % 0.69 [ 0.25, 1.88 ] Yeka 2004 UGA 104/551 158/557 94.7 % 0.67 [ 0.54, 0.83 ] Total (95% CI) 672 682 100.0 % 0.67 [ 0.54, 0.82 ] Total events: 110 (AS+AQ), 167 (AQ+SP) Heterogeneity: Chi 2 = 0.00, df = 1 (P = 0.95); I 2 =0.0% Test for overall effect: Z = 3.73 (P = 0.00019) 0.2 0.5 1 2 5 Favours ASAQ Favours AQSP Analysis 13.4. Comparison 13 Artesunate plus amodiaquine vs Amodiaquine plus sulfadoxinepyrimethamine, Outcome 4 Gametocyte carriage. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 13 Artesunate plus amodiaquine vs Amodiaquine plus sulfadoxine-pyrimethamine Outcome: 4 Gametocyte carriage Study or subgroup AS+AQ AQ+SP Risk Ratio Risk Ratio 1 Gametocyte carriage day 0 n/N n/N M-H,Random,95% CI M-H,Random,95% CI Faye 2003 SEN 0/360 5/161 0.04 [ 0.00, 0.73 ] Dorsey 2006 UGA 16/111 12/111 1.33 [ 0.66, 2.69 ] Menard 2006 MDG 3/83 2/83 1.50 [ 0.26, 8.75 ] Subtotal (95% CI) 554 355 0.69 [ 0.13, 3.59 ] Total events: 19 (AS+AQ), 19 (AQ+SP) Heterogeneity: Tau 2 = 1.36; Chi 2 = 5.97, df = 2 (P = 0.05); I 2 =66% Test for overall effect: Z = 0.44 (P = 0.66) 2 Gametocyte carriage day 3 Faye 2003 SEN 0/360 16/161 0.01 [ 0.00, 0.23 ] 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 ASAQ Favours AQSP (Continued ...) 197
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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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(... Continued) Study or subgroup D
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Analysis 1.12. Comparison 1 Dihydro
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(... Continued) Study or subgroup D
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(Continued) Efficacy: Total Failure
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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) Efficacy: Total Failure
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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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