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Meta-Analysis
. 2005 Oct 19;2005(4):CD005564.
doi: 10.1002/14651858.CD005564.

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

A A A Omari  1 , C Gamble, P Garner
Affiliations
Meta-Analysis

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

A A A Omari et al. Cochrane Database Syst Rev. .

Abstract

Background: The World Health Organization recommends artemether-lumefantrine for treating uncomplicated malaria. We sought evidence of superiority of the six-dose regimen over existing treatment regimens as well as its effectiveness in clinical situations.

Objectives: To evaluate the six-dose regimen of artemether-lumefantrine for treating uncomplicated falciparum malaria.

Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), conference proceedings, and reference lists of articles. We also contacted experts in malaria research and the pharmaceutical company that manufactures artemether-lumefantrine.

Selection criteria: Randomized controlled trials comparing six doses of artemether-lumefantrine administered orally with standard treatment regimens (single drug or combination), or supervised with unsupervised treatment, for uncomplicated falciparum malaria.

Data collection and analysis: Two authors independently applied inclusion criteria to potentially relevant trials, assessed trial quality, and extracted data, including adverse events. Total failure by day 28 (day 42 for sulfadoxine-pyrimethamine and day 63 for mefloquine) was the primary outcome.

Main results: Nine trials (4547 participants) tested the six-dose regimen. Total failure at day 28 for artemether-lumefantrine was lower when compared with amodiaquine (270 participants, 1 trial), amodiaquine plus sulfadoxine-pyrimethamine (507 participants, 1 trial), but not with chloroquine plus sulfadoxine-pyrimethamine (201 participants, 2 trials). In comparisons with artemisinin derivative combinations, artemether-lumefantrine performed better than amodiaquine plus artesunate (668 participants, 2 trials), worse than mefloquine plus artesunate (270 participants, 4 trials), and no differently to dihydroartemisinin-napthoquine-trimethoprim (89 participants, 1 trial).

Authors' conclusions: The six-dose regimen of artemether-lumefantrine appears more effective than antimalarial regimens not containing artemisinin derivatives.

PubMed Disclaimer

Conflict of interest statement

Paul Garner and Carrol Gamble (né Preston) were unpaid technical advisers to a World Health Organization meeting on 19 and 20 February, 2001 considering efficacy and effectiveness studies of co‐artemether‐lumefantrine. The World Health Organization paid for their travel and accommodation, and a representative of Novartis chaired the meeting. Aika Omari: none known

Figures

1.1
1.1. Analysis
Comparison 1 Artemether‐lumefantrine vs amodiaquine, Outcome 1 Total failure by day 28.
1.2
1.2. Analysis
Comparison 1 Artemether‐lumefantrine vs amodiaquine, Outcome 2 Total failure by day 14.
1.3
1.3. Analysis
Comparison 1 Artemether‐lumefantrine vs amodiaquine, Outcome 3 Gametocyte carriage on day 14.
2.1
2.1. Analysis
Comparison 2 Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine, Outcome 1 Total failure by day 28.
2.2
2.2. Analysis
Comparison 2 Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine, Outcome 2 Total failure by days 42, 14, and 7.
2.3
2.3. Analysis
Comparison 2 Artemether‐lumefantrine vs chloroquine plus sulfadoxine‐pyrimethamine, Outcome 3 Gametocyte carriage on days 28, 14, and 7.
3.1
3.1. Analysis
Comparison 3 Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine, Outcome 1 Total failure by day 28.
3.2
3.2. Analysis
Comparison 3 Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine, Outcome 2 Total failure by day 14.
3.3
3.3. Analysis
Comparison 3 Artemether‐lumefantrine vs amodiaquine plus sulfadoxine‐pyrimethamine, Outcome 3 Gametocyte carriage on day 14.
4.1
4.1. Analysis
Comparison 4 Artemether‐lumefantrine vs amodiaquine plus artesunate, Outcome 1 Total failure by day 28.
4.2
4.2. Analysis
Comparison 4 Artemether‐lumefantrine vs amodiaquine plus artesunate, Outcome 2 Total failure by day 14.
4.3
4.3. Analysis
Comparison 4 Artemether‐lumefantrine vs amodiaquine plus artesunate, Outcome 3 Gametocyte carriage on days 14 and 7.
5.1
5.1. Analysis
Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 1 Total failure by day 28.
5.2
5.2. Analysis
Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 2 Total failure by day 28: PCR adjusted.
5.3
5.3. Analysis
Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 3 Total failure by day 42.
5.4
5.4. Analysis
Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 4 Total failure by day 42: PCR adjusted.
5.5
5.5. Analysis
Comparison 5 Artemether‐lumefantrine vs mefloquine plus artesunate, Outcome 5 Gametocyte carriage on day 7 and in first 72 h.
6.1
6.1. Analysis
Comparison 6 Artemether‐lumefantrine vs dihydroartemisinin‐napthoquine‐trimethoprim (DNP), Outcome 1 Total failure by day 28.
7.1
7.1. Analysis
Comparison 7 Artemether‐lumefantrine: supervised vs unsupervised treatment, Outcome 1 Total failure by day 28.
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References to other published versions of this review

Omari 2002
    1. Omari AAA, Gamble C, Garner P. Artemether‐lumefantrine for treating uncomplicated falciparum malaria. Cochrane Database of Systematic Reviews 2002, Issue 3. - PMC - PubMed
Omari 2003
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