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

9 Serious indirectness: Only one trial conducted in Peru in a low transmission setting. Children age < 5 years and pregnant and lactating
women were excluded.
10 Very serious imprecision: The 95% CI of the pooled estimate is wide including appreciable benefit or harm with each drug over the
other. Both drugs performed very well and there were too few events to detect a difference between the two drugs.
11 No serious imprecision: Both limits of the 95% CI suggest appreciable benefit with AS+MQ.
12 Overall five trials assessed P. vivax response. No differences were shown in occurrence of vivax parasitaemia at any time point or
between those with or without vivax co-infection at baseline.
13 No serious indirectness: Trials conducted in Asia and South America in low and unstable transmission areas.
14 No serious limitations: Allocation concealment was assessed as ’low risk of bias’ in three out of four trials.
15 Serious imprecision: The 95% CI of the pooled estimate includes appreciable benefit with AS+MQ over DHA-P and crosses the line
of no effect.
16 No serious limitations: Allocation concealment was assessed as ’low risk of bias’ in all four trials.
17 No serious limitations: Allocation concealment was judged to be at ’low risk of bias’ in five out of eight trials.
18 Serious limitations: All trials were open label and judged to be at ’high risk of bias’ for blinding.
19 Serious imprecision: The 95% CI of the pooled estimate includes appreciable benefit with DHA-P and crosses the line of no effect.
Is Dihydroartemisinin-piperaquine as effective as Artemether-lumefantrine for treating uncomplicated malaria?
Patient or population: Patients with uncomplicated malaria
Settings: Endemic areas worldwide
Intervention: Dihydroartemisinin-piperaquine
Comparison: Artemether-lumefantrine
Outcomes Illustrative comparative risks* (95% CI) Relative effect
(95% CI)
Efficacy: Total Failure
(P. falciparum)
Day 42 PCR adjusted
- Africa
Efficacy: Total Failure
(P. falciparum)
Day 42 PCR unadjusted
- Africa
Assumed risk Corresponding
risk
Artemether- lumefantrine
Dihydroartemisininpiperaquine
117 per 1000 46 per 1000
(28 to 75)
380 per 1000 167 per 1000
(76 to 361)
RR 0.39
(0.24 to 0.64)
RR 0.44
(0.20 to 0.95)
Artemisinin-based combination therapy for treating uncomplicated malaria (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
No of participants
(studies)
869
(3)
1136
(3)
Quality of the evidence
(GRADE)
⊕⊕⊕⊕
high 1,2,3,4,5,6,7
⊕⊕⊕
moderate 2,3,4,6,8,9
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