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

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Analysis 15.3. Comparison 15 Dihydroartemisinin-piperaquine dose analysis (versus Artesunate plus mefloquine), Outcome 3 Total Failure Day 42 PCR unadjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 15 Dihydroartemisinin-piperaquine dose analysis (versus Artesunate plus mefloquine) Outcome: 3 Total Failure Day 42 PCR unadjusted Study or subgroup DHA-P ASMQ Risk Ratio Weight Risk Ratio 1 DHA-P 4 doses n/N n/N M-H,Random,95% CI M-H,Random,95% CI Ashley 2004 THA 10/155 19/157 22.7 % 0.53 [ 0.26, 1.11 ] Janssens 2003 KHM 9/195 9/207 19.0 % 1.06 [ 0.43, 2.62 ] Tran 2002 VNM 16/166 7/77 20.2 % 1.06 [ 0.45, 2.47 ] Subtotal (95% CI) 516 441 62.0 % 0.80 [ 0.50, 1.28 ] Total events: 35 (DHA-P), 35 (ASMQ) Heterogeneity: Tau 2 = 0.0; Chi 2 = 1.98, df = 2 (P = 0.37); I 2 =0.0% Test for overall effect: Z = 0.94 (P = 0.35) 2 DHA-P 3 doses Ashley 2004 THA 6/163 19/157 19.3 % 0.30 [ 0.12, 0.74 ] Mayxay 2004 LAO 4/106 5/108 12.7 % 0.82 [ 0.23, 2.95 ] Smithuis 2004 MMR 6/319 1/316 6.1 % 5.94 [ 0.72, 49.09 ] Subtotal (95% CI) 588 581 38.0 % 0.88 [ 0.20, 3.81 ] Total events: 16 (DHA-P), 25 (ASMQ) Heterogeneity: Tau 2 = 1.17; Chi 2 = 7.05, df = 2 (P = 0.03); I 2 =72% Test for overall effect: Z = 0.17 (P = 0.86) Total (95% CI) 1104 1022 100.0 % 0.77 [ 0.43, 1.35 ] Total events: 51 (DHA-P), 60 (ASMQ) Heterogeneity: Tau 2 = 0.23; Chi 2 = 9.63, df = 5 (P = 0.09); I 2 =48% Test for overall effect: Z = 0.92 (P = 0.36) 0.01 0.1 1 10 100 Favours DHA-P Favours ASMQ Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 204
Analysis 15.4. Comparison 15 Dihydroartemisinin-piperaquine dose analysis (versus Artesunate plus mefloquine), Outcome 4 Total Failure Day 42 PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 15 Dihydroartemisinin-piperaquine dose analysis (versus Artesunate plus mefloquine) Outcome: 4 Total Failure Day 42 PCR adjusted Study or subgroup DHA-P ASMQ Risk Ratio Weight Risk Ratio 1 DHA-P 4 doses n/N n/N M-H,Random,95% CI M-H,Random,95% CI Ashley 2004 THA 1/146 7/145 18.9 % 0.14 [ 0.02, 1.14 ] Janssens 2003 KHM 3/189 2/200 22.9 % 1.59 [ 0.27, 9.39 ] Tran 2002 VNM 2/152 1/71 15.7 % 0.93 [ 0.09, 10.13 ] Subtotal (95% CI) 487 416 57.5 % 0.62 [ 0.14, 2.82 ] Total events: 6 (DHA-P), 10 (ASMQ) Heterogeneity: Tau 2 = 0.69; Chi 2 = 3.24, df = 2 (P = 0.20); I 2 =38% Test for overall effect: Z = 0.62 (P = 0.54) 2 DHA-P 3 doses Ashley 2004 THA 1/158 7/145 18.9 % 0.13 [ 0.02, 1.05 ] Mayxay 2004 LAO 1/103 1/104 12.7 % 1.01 [ 0.06, 15.93 ] Smithuis 2004 MMR 2/315 0/315 10.9 % 5.00 [ 0.24, 103.73 ] Subtotal (95% CI) 576 564 42.5 % 0.70 [ 0.08, 5.87 ] Total events: 4 (DHA-P), 8 (ASMQ) Heterogeneity: Tau 2 = 1.80; Chi 2 = 4.05, df = 2 (P = 0.13); I 2 =51% Test for overall effect: Z = 0.33 (P = 0.74) Total (95% CI) 1063 980 100.0 % 0.62 [ 0.20, 1.91 ] Total events: 10 (DHA-P), 18 (ASMQ) Heterogeneity: Tau 2 = 0.62; Chi 2 = 7.30, df = 5 (P = 0.20); I 2 =32% Test for overall effect: Z = 0.84 (P = 0.40) 0.002 0.1 1 10 500 Favours DHA-P Favours ASMQ Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 205
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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) 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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