12. Dihydroartemisinin‐piperaquine compared to Artesunate plus mefloquine for treating uncomplicated P. falciparum malaria in Asia.
| Dihydroartemisinin‐piperaquine compared to Artesunate plus mefloquine for treating uncomplicated P. falciparum malaria in Asia | |||||
| Patient or population: Patients with treating uncomplicated P. falciparum malaria Settings: Endemic settings in Asia Intervention: Dihydroartemisinin‐piperaquine (DHA‐P) Comparison: Artesunate plus mefloquine (AS+MQ) | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| AS+MQ | DHA‐P | ||||
|
Treatment failure Day 28 |
PCR‐unadjusted | RR 1.02 (0.28 to 3.72) | 3487 (8 trials) | ⊕⊕⊕⊕ high1,2,3,4 | |
| 2 per 100 | 2 per 100 (1 to 8) | ||||
| PCR‐adjusted | RR 0.41 (0.21 to 0.8) | 3467 (8 trials) | ⊕⊕⊕⊕ high1,2,3,5 | ||
| 1 per 100 | 0 per 100 (0 to 1) | ||||
|
Treatment failure Day 63 |
PCR‐unadjusted | RR 0.84 (0.69 to 1.03) | 2715 (5 trials) | ⊕⊕⊕⊝ moderate1,6,7,8 | |
| 12 per 100 | 10 per 100 (8 to 13) | ||||
| PCR‐adjusted | RR 0.5 (0.3 to 0.84) | 2500 (5 trials) | ⊕⊕⊕⊕ high1,7,8,9 | ||
| 3 per 100 | 2 per 100 (1 to 3) | ||||
| *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 risk of selection bias and detection bias. Exclusion of trials as high or unclear risk of bias did not change the result. 2 No serious inconsistency: Six trials found very few recurrent parasitaemia in both groups. Two trials primarily conducted in Thailand in areas with multi‐drug resistance found an increased risk of recurrent parasitaemia with AS+MQ. 3 No serious indirectness: The trials were conducted in adults and children in Vietnam, Thailand, Cambodia, Myanmar, India, and Laos. 4 No serious imprecision: The overall result is of no significant difference between treatments. However, where there is P. falciparum resistance to mefloquine, DHA‐P may be superior. 5 No serious imprecision: The overall result is of a statistically significant benefit with DHA‐P although this benefit may only be present where there is resistance to mefloquine. 6 Downgraded by one for serious inconsistency: Of the five trials, one from Thailand in 2005 found a statistically significant benefit with DHA‐P, one from Myanmar in 2009 found a benefit with DHA‐P, and three found no difference. 7 No serious indirectness: The trials were conducted in adults and children in Thailand, Cambodia, Myanmar, India, and Laos. 8 No serious imprecision: The overall result is of no significant difference between treatments. Although some trials found statistically significant differences, these may not be clinically important. 9 No serious inconsistency: There is a small amount of variability between trials, with only one trial showing a statistically significant benefit with DHA‐P.