15. Dihydroartemisinin‐piperaquine compared to Artesunate plus amodiaquine for treating uncomplicated P. falciparum malaria in Asia.
| Dihydroartemisinin‐piperaquine compared to Artesunate plus amodiaquine for treating uncomplicated P. falciparum malaria in Asia | |||||
| Patient or population: Patients with treating uncomplicated P. falciparum malaria Settings: Asia Intervention: Dihydroartemisinin‐piperaquine (DHA‐P) Comparison: Artesunate plus amodiaquine (AS+AQ) | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| AS+AQ | DHA‐P | ||||
|
Treatment failure Day 28 |
PCR‐unadjusted | RR 0.38 (0.18 to 0.77) | 482 (2 trials) | ⊕⊕⊕⊝ moderate1,2,3,4 | |
| 11 per 100 | 4 per 100 (2 to 8) | ||||
| PCR‐adjusted | RR 0.08 (0.01 to 0.4) | 466 (2 trials) | ⊕⊕⊕⊝ moderate1,2,3,4 | ||
| 8 per 100 | 1 per 100 (0 to 3) | ||||
|
Treatment failure Day 63 |
PCR‐unadjusted | RR 0.49 (0.27 to 0.89) | 304 (1 trial) | ⊕⊕⊝⊝ low4,5,6,7 | |
| 19 per 100 | 9 per 100 (5 to 17) | ||||
| PCR‐adjusted | RR 0.14 (0.03 to 0.59) | 278 (1 trial) | ⊕⊕⊝⊝ low4,5,6,7 | ||
| 10 per 100 | 1 per 100 (0 to 6) | ||||
| *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 bias. Exclusion of trials as high or unclear risk of selection bias or detection bias did not change the result. 2 No serious inconsistency: The trials all had similar results and statistical heterogeneity was low. 3 No serious indirectness: The trials were conducted in adults and children in Indonesia and Myanmar. 4 Downgraded by 1 for serious imprecision: Although this result reached statistical significance there are limited data, with few events. Larger trials are needed to have full confidence in this result. 5 No serious risk of bias: This finding is only reported in one trial which was generally at low risk of bias. 6 Downgraded by 1 for serious indirectness: This trial was from a single setting in Myanmar, and may not be easily generalized to elsewhere. 7 One trial from Indonesia conducted in 2007 presented day 42 outcomes and at this timepoint there was still an advantage on PCR‐unadjusted treatment failure with DHA‐P (RR 0.27, 95% CI 0.10 to 0.72, one trial, 152 participants, moderate quality evidence), and PCR‐adjusted treatment failure (RR 0.10, 95% CI 0.01 to 0.81, one trial, 141 participants, moderate quality evidence).