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Meta-Analysis
. 2006 Apr 19;2006(2):CD005965.
doi: 10.1002/14651858.CD005965.

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

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

Artemether-lumefantrine (four-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, an expensive drug, as a treatment for uncomplicated malaria. We sought evidence of the superiority of the four-dose regimen over existing treatments.

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

Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (October 2005), CENTRAL (The Cochrane Library 2005, Issue 3), MEDLINE (1966 to October 2005), EMBASE (1988 to October 2005), LILACS (1982 to October 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 four doses of artemether-lumefantrine with standard treatment regimens (single drug or combination), or six doses of artemether-lumefantrine, for treating 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: Seven trials (2057 participants) tested a four-dose regimen. More people tended to fail treatment with artemether-lumefantrine than with other drugs, including sulfadoxine-pyrimethamine (247 participants, 1 trial), halofantrine (86 participants, 1 trial), and mefloquine (233 participants, 1 trial; difference statistically significant for mefloquine). When compared with chloroquine, artemether-lumefantrine was better in two trials (378 participants), but over 50% of the participants treated with chloroquine had total failure by day 28. Fewer people failed treatment with the six-dose regimen compared to the four-dose regimen (RR 7.71, 95% CI 2.99 to 19.88; 306 participants, 1 trial).

Authors' conclusions: The four-dose regimen of artemether-lumefantrine seems to be less effective than regimens against which it has been tested. The six-dose regimen is superior to four-dose regimen.

PubMed Disclaimer

Conflict of interest statement

Paul Garner and Carrol Gamble (né Preston) were unpaid technical advisers to a World Health Organization meeting (19 and 20 February 2001) considering efficacy and effectiveness studies of artemether‐lumefantrine. The World Health Organization paid for their travel and accommodation, and a representative of Novartis chaired the international meeting.

Aika Omari: none known.

Figures

1.1
1.1. Analysis
Comparison 1 Artemether‐lumefantrine (4 doses) versus sulfadoxine‐pyrimethamine, Outcome 1 Total failure by day 14.
1.2
1.2. Analysis
Comparison 1 Artemether‐lumefantrine (4 doses) versus sulfadoxine‐pyrimethamine, Outcome 2 Total failure by day 14 (excluding new infections).
1.3
1.3. Analysis
Comparison 1 Artemether‐lumefantrine (4 doses) versus sulfadoxine‐pyrimethamine, Outcome 3 Gametocyte carriage by day 4.
1.4
1.4. Analysis
Comparison 1 Artemether‐lumefantrine (4 doses) versus sulfadoxine‐pyrimethamine, Outcome 4 Gametocyte carriage by day 15.
2.1
2.1. Analysis
Comparison 2 Artemether‐lumefantrine (4 doses) versus mefloquine, Outcome 1 Total failure by day 28.
2.2
2.2. Analysis
Comparison 2 Artemether‐lumefantrine (4 doses) versus mefloquine, Outcome 2 Gametocyte carriage within the first 72 h.
3.1
3.1. Analysis
Comparison 3 Artemether‐lumefantrine (4 doses) versus halofantrine, Outcome 1 Total failure by day 28.
3.2
3.2. Analysis
Comparison 3 Artemether‐lumefantrine (4 doses) versus halofantrine, Outcome 2 Gametocyte carriage within the first 72 h.
4.1
4.1. Analysis
Comparison 4 Artemether‐lumefantrine (4 doses) versus chloroquine, Outcome 1 Total failure by day 28.
4.2
4.2. Analysis
Comparison 4 Artemether‐lumefantrine (4 doses) versus chloroquine, Outcome 2 Gametocyte carriage within the first 72 h.
5.1
5.1. Analysis
Comparison 5 Artemether‐lumefantrine versus mefloquine plus artesunate, Outcome 1 Total failure by day 28.
5.2
5.2. Analysis
Comparison 5 Artemether‐lumefantrine versus mefloquine plus artesunate, Outcome 2 Total failure by day 28 (excluding new infections).
5.3
5.3. Analysis
Comparison 5 Artemether‐lumefantrine versus mefloquine plus artesunate, Outcome 3 Total failure by day 63.
5.4
5.4. Analysis
Comparison 5 Artemether‐lumefantrine versus mefloquine plus artesunate, Outcome 4 Gametocyte carriage within the first 72 h.
6.1
6.1. Analysis
Comparison 6 Artemether‐lumefantrine (4 doses) versus artemether‐lumefantrine (6 doses), Outcome 1 Total failure by day 28.
See this image and copyright information in PMC

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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. [DOI: 10.1002/14651858.CD003125.pub2] - DOI - PMC - PubMed
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