11. Dihydroartemisinin‐piperaquine compared to Artemether‐lumefantrine for uncomplicated P. falciparum malaria in Asia and Oceania.
| Dihydroartemisinin‐piperaquine compared to Artemether‐lumefantrine for uncomplicated P. falciparum malaria in Asia | |||||
| Patient or population: Patients with uncomplicated P. falciparum malaria Settings: Asia and Oceania Intervention: Dihydroartemisinin‐piperaquine (DHA‐P) Comparison: Artemether‐lumefantrine (AL6) | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| AL6 | DHA‐P | ||||
|
Treatment failure Day 28 |
PCR‐unadjusted | RR 0.97 (0.64 to 1.47) | 1143 (4 trials) | ⊕⊕⊕⊝ moderate1,2,3,4 | |
| 7 per 100 | 7 per 100 (4 to 10) | ||||
| PCR‐adjusted | RR 2.01 (0.81 to 5.03) | 925 (3 trials) | ⊕⊕⊕⊝ moderate1,2,3,4 | ||
| 1 per 100 | 3 per 100 (1 to 7) | ||||
|
Treatment failure Day 63 |
PCR‐unadjusted | RR 0.94 (0.47 to 1.88) | 323 (1 trial) | ⊕⊕⊝⊝ low4,5,6,7 | |
| 9 per 100 | 8 per 100 (4 to 17) | ||||
| PCR‐adjusted | RR 1.00 (0.14 to 7.01) | 298 (1 trial) | ⊕⊕⊝⊝ low4,5,6,7 | ||
| 1 per 100 | 1 per 100 (0 to 7) | ||||
| *The basis for the assumed risk (for example, the median control group risk across trials) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1 No serious risk of bias: Trials are generally at low or unclear risk of bias. Exclusion of trials as high risk of selection bias or detection bias did not change the result. 2 No serious inconsistency: Statistical heterogeneity was low. 3 No serious indirectness: The trials were conducted in adults and children in Indonesia, Thailand, Papua New Guinea, and Myanmar. 4 Downgraded by 1 for serious imprecision: The 95% CI is wide and includes appreciable differences between drugs. 5 No serious risk of bias: This single trial is generally at low risk of bias. 6 Downgraded by 1 for serious indirectness: This single trial is from Myanmar. The results may not be easily generalized to elsewhere. 7 Two trials from Indonesia and Papua New Guinea reported outcomes at Day 42. At this timepoint there was no difference in PCR unadjusted or PCR adjusted treatment failure (two trials, 572 participants, low quality evidence).