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

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Analysis 18.1. Comparison 18 How does Dihydroartemisinin-piperaquine perform?, Outcome 1 Effectiveness: Total Failure (P. falciparum) PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 18 How does Dihydroartemisinin-piperaquine perform? Outcome: 1 Effectiveness: Total Failure (P. falciparum) PCR adjusted Study or subgroup DHA-P Control Risk Ratio Weight Risk Ratio 1 Day 63: DHA-P vs Artesunate plus mefloquine n/N n/N M-H,Random,95% CI M-H,Random,95% CI Ashley 2003b THA 3/131 9/131 31.2 % 0.33 [ 0.09, 1.20 ] Janssens 2003 KHM 4/181 5/190 30.8 % 0.84 [ 0.23, 3.08 ] Ashley 2004 THA 3/292 7/137 29.6 % 0.20 [ 0.05, 0.77 ] Grande 2005 PER 4/211 0/224 8.4 % 9.55 [ 0.52, 176.35 ] Subtotal (95% CI) 815 682 100.0 % 0.57 [ 0.17, 1.83 ] Total events: 14 (DHA-P), 21 (Control) Heterogeneity: Tau 2 = 0.78; Chi 2 = 6.94, df = 3 (P = 0.07); I 2 =57% Test for overall effect: Z = 0.95 (P = 0.34) 2 Day 42: DHA-P vs Artemether-lumefantrine Ratcliff 2005 IDN 3/179 3/138 11.7 % 0.77 [ 0.16, 3.76 ] Kamya 2006 UGA 13/130 28/117 31.8 % 0.42 [ 0.23, 0.77 ] Karunajeewa 2007 PNG 12/77 5/74 21.3 % 2.31 [ 0.85, 6.23 ] Zongo 2007 BFA 4/163 7/128 17.0 % 0.45 [ 0.13, 1.50 ] Yeka 2007 UGA 4/190 10/141 18.2 % 0.30 [ 0.10, 0.93 ] Subtotal (95% CI) 739 598 100.0 % 0.62 [ 0.29, 1.30 ] Total events: 36 (DHA-P), 53 (Control) Heterogeneity: Tau 2 = 0.42; Chi 2 = 10.17, df = 4 (P = 0.04); I 2 =61% Test for overall effect: Z = 1.26 (P = 0.21) 3 Day 28: DHA-P vs Artesunate plus amodiaquine Karema 2004 RWA 10/236 16/222 78.2 % 0.59 [ 0.27, 1.27 ] Hasugian 2005 IDN 1/90 6/81 21.8 % 0.15 [ 0.02, 1.22 ] Subtotal (95% CI) 326 303 100.0 % 0.42 [ 0.13, 1.35 ] Total events: 11 (DHA-P), 22 (Control) Heterogeneity: Tau 2 = 0.31; Chi 2 = 1.47, df = 1 (P = 0.22); I 2 =32% Test for overall effect: Z = 1.46 (P = 0.15) 4 Day 42: DHA-P vs Artesunate plus sulfadoxine-pyrimethamine Karunajeewa 2007 PNG 12/77 17/84 100.0 % 0.77 [ 0.39, 1.51 ] Subtotal (95% CI) 77 84 100.0 % 0.77 [ 0.39, 1.51 ] Total events: 12 (DHA-P), 17 (Control) 0.005 0.1 1 10 200 Favours DHA-P Favours Control Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued ...) 210
(... Continued) Study or subgroup DHA-P Control Risk Ratio Weight Risk Ratio Heterogeneity: not applicable Test for overall effect: Z = 0.76 (P = 0.45) 5 Day 28: DHA-P vs Amodiaquine plus sulfadoxine-pyrimethamine n/N n/N M-H,Random,95% CI M-H,Random,95% CI Karema 2004 RWA 10/236 38/227 63.8 % 0.25 [ 0.13, 0.50 ] Zongo 2007 BFA 4/172 7/167 36.2 % 0.55 [ 0.17, 1.86 ] Subtotal (95% CI) 408 394 100.0 % 0.32 [ 0.16, 0.64 ] Total events: 14 (DHA-P), 45 (Control) Heterogeneity: Tau 2 = 0.06; Chi 2 = 1.24, df = 1 (P = 0.27); I 2 =19% Test for overall effect: Z = 3.23 (P = 0.0012) 0.005 0.1 1 10 200 Favours DHA-P Favours Control Analysis 19.1. Comparison 19 How does Artesunate plus mefloquine perform?, Outcome 1 Effectiveness: Total Failure (P. falciparum) PCR adjusted. Review: Artemisinin-based combination therapy for treating uncomplicated malaria Comparison: 19 How does Artesunate plus mefloquine perform? Outcome: 1 Effectiveness: Total Failure (P. falciparum) PCR adjusted Study or subgroup ASMQ Control Risk Ratio Risk Ratio 1 Day 63: AS+MQ vs Dihydroartemisinin-piperaquine n/N n/N M-H,Random,95% CI M-H,Random,95% CI Ashley 2003b THA 9/131 3/131 3.00 [ 0.83, 10.83 ] Janssens 2003 KHM 5/190 4/181 1.19 [ 0.32, 4.36 ] Ashley 2004 THA 7/137 3/292 4.97 [ 1.31, 18.94 ] Grande 2005 PER 0/224 4/211 0.10 [ 0.01, 1.93 ] Subtotal (95% CI) 682 815 1.77 [ 0.55, 5.72 ] Total events: 21 (ASMQ), 14 (Control) Heterogeneity: Tau 2 = 0.78; Chi 2 = 6.94, df = 3 (P = 0.07); I 2 =57% Test for overall effect: Z = 0.95 (P = 0.34) 2 Day 42: AS+MQ vs Artemether-lumefantrine Hutagalung 2002 THA 9/212 3/201 2.84 [ 0.78, 10.36 ] Van den Broek 2003a BGD 0/105 3/102 0.14 [ 0.01, 2.65 ] Stohrer 2003 LAO 0/45 3/37 0.12 [ 0.01, 2.21 ] Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 0.005 0.1 1 10 200 Favours ASMQ Favours Control (Continued ...) 211
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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) Study or subgroup A
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(Continued) Harms: Early vomiting -
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1 Dorsey 2006 UGA; Faye 2003 SEN; K
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