Comparison of the efficacy of artemether-lumefantrine vs. artesunate plus sulfadoxine-pyrimethamine in children with uncomplicated falciparum malaria

Rachmawati, Rachmawati; Rampengan, Novie Homenta; Tatura, Suryadi N. N.; Rampengan, T. H.

doi:10.14238/pi50.2.2010.113-7

Cited by 1 publication

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“…The initial search produced 13640 hits. After removal of duplicates and screening of titles and abstracts, 34 full-text papers were evaluated and 17 studies, incorporating 5043 total number of patients were finally selected for this review [14, 23–38]. The highest number of trials include DHP compared to ASMQ (n = 5), followed by artemisinin-piperaquine (AMPQ) to DHP (n = 3) and AL to ASMQ (n = 2).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 provides the key characteristics of the studies identified. The number of participants varied from 47 [14] to 769 [36]. The majority of participants in the studies included were males (range from 51% to 96%) with mean age between 5.9 to 29 years.…”

Section: Resultsmentioning

confidence: 99%

“…falciparum parasitaemia within seven days of initiation of trial drug, without subsequent recrudescence within 28 days after initiation of study). Recrudescence was defined as the existence of positive blood smears after initial clearance of parasites from the peripheral blood [14].…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of antimalarial drugs for treatment of uncomplicated falciparum malaria in Asian region: A network meta-analysis

et al. 2019

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BackgroundThe WHO recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria. Hence, monitoring the efficacy of antimalarial drugs is a key component of malaria control and elimination. The published randomized trials that assessed comparisons of ACTs for treating uncomplicated falciparum malaria reported conflicting results in treatment efficacy. A network meta-analysis is an extension of pairwise meta-analysis that can synthesize evidence simultaneously from both direct and indirect treatment comparisons. The objective was to synthesize evidence on the comparative efficacy of antimalarial drugs for treatment of uncomplicated falciparum malaria in Asian region.MethodsRelevant randomized trials that assessed efficacy of antimalarial drugs for patients having uncomplicated falciparum malaria in Asian region were searched in health-related databases. We evaluated the methodological quality of the included studies with the Cochrane risk of bias tool. Main outcome was treatment success at day 28 as determined by the absence of parasiteamia. We performed network meta-analysis of the interventions in the trials, and assessed the overall quality of evidence using the GRADE approach.ResultsSeventeen randomized trials (n = 5043) were included in this network meta-analysis study. A network geometry was formed with 14 antimalarial treatment options such as artemether-lumefantrine (AL), artemisinin-piperaquine, artesunate-amodiaquine, artesunate-mefloquine (ASMQ), artesunate-chloroquine, artesunate-mefloquine home treatment, artesunate-mefloquine 2-day course, artesunate plus sulfadoxine-pyrimethamine, chloroquine, dihydroartemisinin-piperaquine (DHP), dihydroartemisinin-piperaquine home treatment, dihydroartemisinin-piperaquine 4-day course, dihydroartemisinin-piperaquine and added artesunate, sulfadoxine-pyrimethamine. A maximum number of trials included was DHP compared to ASMQ (n = 5). In general, DHP had better efficacy than AL at day 28 (DHP vs AL: OR 2.5, 95%CI:1.08–5.8). There is low certainty evidence due to limited number of studies and small trials.Discussion/ ConclusionsThe findings suggest the superiority of DHP (3–day course) to AL and other comparator ACTs are with the overall low/very low quality of evidence judgements. Moreover, one drug regimen is better than another is only if current drug-resistance patterns are at play. For example, the AL might be better than DHP in areas where both artemisinin and piperaquine resistance patterns are prevalent. For substantiation, well-designed larger trials from endemic countries are needed. In the light of benefit versus harm concept, future analysis with safety information is recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%