Artemether‐lumefantrine (six‐dose regimen) for treating uncomplicated falciparum malaria

Aika AA Omari; Carrol L Gamble; Paul Garner

doi:10.1002/14651858.CD005564

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Analysis 1.1

Comparison 1 Artemether‐lumefantrine vs amodiaquine, Outcome 1 Total failure by day 28.

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Analysis 1.2

Comparison 1 Artemether‐lumefantrine vs amodiaquine, Outcome 2 Total failure by day 14.

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Analysis 1.3

Comparison 1 Artemether‐lumefantrine vs amodiaquine, Outcome 3 Gametocyte carriage on day 14.

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Analysis 2.1

Comparison 2 Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine, Outcome 1 Total failure by day 28.

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Analysis 2.2

Comparison 2 Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine, Outcome 2 Total failure by days 42, 14, and 7.

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Analysis 2.3

Comparison 2 Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine, Outcome 3 Gametocyte carriage on days 28, 14, and 7.

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Analysis 3.1

Comparison 3 Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine, Outcome 1 Total failure by day 28.

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Analysis 3.2

Comparison 3 Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine, Outcome 2 Total failure by day 14.

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Analysis 3.3

Comparison 3 Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine, Outcome 3 Gametocyte carriage on day 14.

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Analysis 4.1

Comparison 4 Artemether‐lumefantrine vs amodiaquine plus artesunate, Outcome 1 Total failure by day 28.

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Analysis 4.2

Comparison 4 Artemether‐lumefantrine vs amodiaquine plus artesunate, Outcome 2 Total failure by day 14.

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Analysis 4.3

Comparison 4 Artemether‐lumefantrine vs amodiaquine plus artesunate, Outcome 3 Gametocyte carriage on days 14 and 7.

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Analysis 5.1

Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 1 Total failure by day 28.

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Analysis 5.2

Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 2 Total failure by day 28: PCR adjusted.

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Analysis 5.3

Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 3 Total failure by day 42.

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Analysis 5.4

Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 4 Total failure by day 42: PCR adjusted.

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Analysis 5.5

Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 5 Gametocyte carriage on day 7 and in first 72 h.

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Analysis 6.1

Comparison 6 Artemether‐lumefantrine vs dihydroartemisinin‐napthoquine‐trimethoprim (DNP), Outcome 1 Total failure by day 28.

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Analysis 7.1

Comparison 7 Artemether‐lumefantrine: supervised vs unsupervised treatment, Outcome 1 Total failure by day 28.

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Table 1. Risk of bias of each included studya

Study	Allocation sequence generation	Allocation concealment	Blinding	Inclusion^b
Krudsood 2003	Not described	Not described	No	Inadequate
Lefevre 2001	Not described	Not described	No	Adequate
Mayxay 2004	Not described	Adequate	No	Adequate
Mutabingwa 2005	Adequate	Adequate	No	Adequate
Ndayiragije 2004	Not described	Not described	No	Adequate
Piola 2005	Adequate	Adequate	No	Adequate
Stohrer 2004	Not described	Adequate	No	Adequate
Sutherland 2005	Not described	Adequate	Single	Inadequate
Van Vugt 2000	Not described	Adequate	No	Inadequate
^aInclusion of all randomized participants in the analysis; see the 'Methods of the review' for the assessment methods, and the 'Characteristics of included studies' for the methods used in each trial.

Table 1. Risk of bias of each included studya

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Comparison 1. Artemether‐lumefantrine vs amodiaquine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Total failure by day 14 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Gametocyte carriage on day 14 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 1. Artemether‐lumefantrine vs amodiaquine

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Comparison 2. Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Total failure by days 42, 14, and 7 Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Day 42	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Day 14	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Day 7	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Gametocyte carriage on days 28, 14, and 7 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3.1 Day 28	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Day 14	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Day 7	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine

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Comparison 3. Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Total failure by day 14 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Gametocyte carriage on day 14 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 3. Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine

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Comparison 4. Artemether‐lumefantrine vs amodiaquine plus artesunate

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Total failure by day 14 Show forest plot	2	1283	Risk Ratio (M‐H, Fixed, 95% CI)	0.11 [0.05, 0.23]

3 Gametocyte carriage on days 14 and 7 Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Day 14	2	941	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.35, 0.91]
3.2 Day 7	1	290	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.33, 1.41]

Comparison 4. Artemether‐lumefantrine vs amodiaquine plus artesunate

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Comparison 5. Artemether‐lumefantrine vs mefloquine plus artesunate

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	2	389	Risk Ratio (M‐H, Fixed, 95% CI)	4.20 [0.55, 31.93]

2 Total failure by day 28: PCR adjusted Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Adjusted for new infections	2	389	Risk Ratio (M‐H, Fixed, 95% CI)	3.50 [0.45, 27.03]
2.2 Not adjusted for new infections	2	389	Risk Ratio (M‐H, Fixed, 95% CI)	4.20 [0.55, 31.93]
3 Total failure by day 42 Show forest plot	2	315	Risk Ratio (M‐H, Fixed, 95% CI)	2.93 [1.48, 5.80]

4 Total failure by day 42: PCR adjusted Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 AL vs. mefloquine plus artesunate, adjusted for new infections	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 AL vs. mefloquine plus artesunate, not adjusted for new infections	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Gametocyte carriage on day 7 and in first 72 h Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.1 Day 7	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.35 [0.44, 4.15]
5.2 72 h	2	240	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.58, 2.06]

Comparison 5. Artemether‐lumefantrine vs mefloquine plus artesunate

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Comparison 6. Artemether‐lumefantrine vs dihydroartemisinin‐napthoquine‐trimethoprim (DNP)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 6. Artemether‐lumefantrine vs dihydroartemisinin‐napthoquine‐trimethoprim (DNP)

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Comparison 7. Artemether‐lumefantrine: supervised vs unsupervised treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total failure by day 28 Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 7. Artemether‐lumefantrine: supervised vs unsupervised treatment

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