Efficacy of antimalarial drugs for treatment of uncomplicated falciparum malaria in Asian region: A network meta-analysis

Abstract

BackgroundThe WHO recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria. Hence, monitoring the efficacy of antimalarial drugs is a key component of malaria control and elimination. The published randomized trials that assessed comparisons of ACTs for treating uncomplicated falciparum malaria reported conflicting results in treatment efficacy. A network meta-analysis is an extension of pairwise meta-analysis that can synthesize evidence simultaneously from both direct and indirect treatment comparisons. The objective was to synthesize evidence on the comparative efficacy of antimalarial drugs for treatment of uncomplicated falciparum malaria in Asian region.MethodsRelevant randomized trials that assessed efficacy of antimalarial drugs for patients having uncomplicated falciparum malaria in Asian region were searched in health-related databases. We evaluated the methodological quality of the included studies with the Cochrane risk of bias tool. Main outcome was treatment success at day 28 as determined by the absence of parasiteamia. We performed network meta-analysis of the interventions in the trials, and assessed the overall quality of evidence using the GRADE approach.ResultsSeventeen randomized trials (n = 5043) were included in this network meta-analysis study. A network geometry was formed with 14 antimalarial treatment options such as artemether-lumefantrine (AL), artemisinin-piperaquine, artesunate-amodiaquine, artesunate-mefloquine (ASMQ), artesunate-chloroquine, artesunate-mefloquine home treatment, artesunate-mefloquine 2-day course, artesunate plus sulfadoxine-pyrimethamine, chloroquine, dihydroartemisinin-piperaquine (DHP), dihydroartemisinin-piperaquine home treatment, dihydroartemisinin-piperaquine 4-day course, dihydroartemisinin-piperaquine and added artesunate, sulfadoxine-pyrimethamine. A maximum number of trials included was DHP compared to ASMQ (n = 5). In general, DHP had better efficacy than AL at day 28 (DHP vs AL: OR 2.5, 95%CI:1.08–5.8). There is low certainty evidence due to limited number of studies and small trials.Discussion/ ConclusionsThe findings suggest the superiority of DHP (3–day course) to AL and other comparator ACTs are with the overall low/very low quality of evidence judgements. Moreover, one drug regimen is better than another is only if current drug-resistance patterns are at play. For example, the AL might be better than DHP in areas where both artemisinin and piperaquine resistance patterns are prevalent. For substantiation, well-designed larger trials from endemic countries are needed. In the light of benefit versus harm concept, future analysis with safety information is recommended.

Efficacy and safety of artemisinin-based combination therapies for the treatment of uncomplicated malaria in pediatrics: a systematic review and meta-analysis

“…Since the initial emergence of partial artemisinin resistance in the region, the GMS have remained the epicentre of antimalarial drug resistance [ 1 ]. Despite these, one network meta-analysis in the Asian region including the above-mentioned GMS areas had showed superiority of DP to other ACTs at day 28 with low quality of evidence [ 44 ]. Similarly, another network meta-analysis on ACT efficacy for uncomplicated P. falciparum malaria in African children and adults showed superiority of DP over other WHO recommended ACTs [ 45 ].…”

Clinical Efficacy and Safety of Artemisinin-based Combination Therapies in the Treatment of Uncomplicated Plasmodium Falciparum Malaria in Cameroon: A Systematic Review and Meta-Analysis from Individual Patient Data (2004-2020)

“…Despite the high success rates of ACTs, resistance to anti-malarial drugs poses a major threat globally and if the parasites develop resistance to these anti-malarial regimens, it is inevitable that treatment would be more di cult, unsuccessful and high rates of relapse could be due to multidrug-resistant malaria. Therefore, monitoring the anti-malarial drug e cacy is important to enable early detection of emergence of drug resistance before it spreads to most of the parasite population, similarly to what happened with chloroquine, sulphadoxine-pyrimethamine, and amodiaquine monotherapies in Cameroon [2,37,38]. More so, there is no guarantee how long the currently used anti-malarial drugs will remain effective based on evidence that previous monotherapies were associated with higher rates of treatment failures in P. falciparum infected patients [2,39].…”

An Investigation of the Effect of Retraining Courses on the Knowledge, Attitude, and Performance of Health Workers in the Field of Malaria

“…The questionnaire had four sections: the first section included items related to demographic characteristics (academic degree, work experience, marriage, gender, employment status, and age), and the second section included knowledge with 18 close items At a scale of 5 degrees, weak (1), medium (2), good (3), excellent ( 4) and no answer (0). The third section included a 10 close items, with a 5-point scale from weak (1), medium (2), good (3), excellent (4), and no answer (0). The fourth section consisted of performance with 10 close items, with a poor 5-point scale from weak (1), medium (2), good (3), excellent (4), to no answer (0).…”

“…The third section included a 10 close items, with a 5-point scale from weak (1), medium (2), good (3), excellent (4), and no answer (0). The fourth section consisted of performance with 10 close items, with a poor 5-point scale from weak (1), medium (2), good (3), excellent (4), to no answer (0). To determine the ratio of content validity and content validity index, the tool was given to 10 experts (8 people fighting disease and 2 health education experts) of Saravan Health Center that after collecting and applying their opinions, and those of the Advisor and Supervisor, necessary modifications were made.…”