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

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Figure 9. How does Artesunate plus amodiaquine perform? Summary of primary outcome: Effectiveness: Total Failure (P. falciparum) PCR adjusted. Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 26
Figure 10. Olliaro-Vaillant plot. Day 28 PCR adjusted treatment failure data for trials of AS+AQ against all comparators are presented in this plot.The horizontal red line represents the WHO standard of 10% treatment failure (PCR corrected). Plots below this line represent trials where AS+AQ performed to this standard.The vertical blue line represents no difference between the two drugs. Plots to the right of this line represent trials where AS+AQ performed better than the comparator drug, and plots to the left represent trials where the comparator drug performed better than AS+AQ. • There is very little good quality evidence available comparing AS+SP to DHA-P, AS+MQ or AL6 but it has performed well in head to head trials with AS+AQ. • The performance of the non-ACT AQ+SP (which is only recommended as an interim measure by the WHO), was inadequate for first-line use in several countries from East Africa. It was, however, still performing well in Senegal in 2003 (Faye 2003 SEN), Madagascar in 2006 (Menard 2006 MDG), and Burkina Faso in 2005 (Zongo 2005 BFA). Efficacy (P. vivax) The two drugs with long half-lives (DHA-P and AS+MQ) have been shown to be superior to AL6 in reducing the incidence of P. vivax following treatment (for either P. falciparum or P. falciparum/ P. vivax co-infections). DHA-P has also been shown to reduce the incidence of P. vivax compared to AS+AQ. Five trials have compared DHA-P and AS+MQ and shown no difference. Artemisinin-based combination therapy for treating uncomplicated malaria (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. There could be some public health benefits to using drugs with long half-lives in this way, to prolong the malaria free period. One trial (Hasugian 2005 IDN) demonstrated a reduced risk of anaemia after treatment with DHA-P. This is likely to be due to the lower incidence of both P. falciparum re-infections and P. vivax in this group. As ACTs are ineffective at treating the liver stages of P. vivax, this effect may be lost as follow up continues as the majority of P. vivax will eventually relapse. Prevention of transmission (as measured by gametocytes) ACTs may be superior to AQ+SP (the only combination not containing an artemisinin derivative) in their effect on gametocytes. Gametocyte carriage at days three and seven was higher with AQ+SP compared to AS+MQ (one trial, 306 participants, Analysis 8.3) and AL6 (four trials, 1538 participants, Analysis 11.5). Gametocyte development in those negative at baseline was also higher 27
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D A T A A N D A N A L Y S E S Compa
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1 Dorsey 2006 UGA; Faye 2003 SEN; K
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