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

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
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