Safety of dihydroartemisinin-piperaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa: a systematic review and meta-analysis of randomized control trials

Malaria Journal

Gizachew Yesmaw¹  Eden Dagnachew Zeleke²  Eyasu Makonnen³  Dawit Getachew Assefa⁴  Andualem Mebratu⁵  Wondwosen Molla⁵  Ahmedin Sefa⁶  Asresu Feleke Bate⁶  Etaferaw Bekele⁶  Nebiyu Mengistu⁷ 

[1] Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;Department of Midwifery, College of Health Science, Bule Hora University, Bule Hora, Ethiopia;Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia;Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia;Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia;Department of Psychiatry, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia;

关键词: Plasmodium falciparum;    Adverse event;    Pediatrics;    Children;    Safety;    Randomized control trial;    Artemisinin-based combination therapy;    Dihydroartemisinin-piperaquine;    Artemether-lumefantrine;    Systematic review;    Meta-analysis, Africa;   

DOI  :  10.1186/s12936-021-04032-2

来源: Springer

【 摘 要 】

BackgroundThe efficacies of artemisinin based combinations have been excellent in Africa, but also comprehensive evidence regarding their safety would be important. The aim of this review was to synthesize available evidence on the safety of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa.MethodsA systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial database (CENTRAL) for retrieving randomized control trials comparing safety of DHA-PQ and AL for treatment of uncomplicated P. falciparum malaria among children in Africa. The search was performed from August 2020 to 30 April 2021. Using Rev-Man software (V5.4.1), the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI).ResultsIn this review, 18 studies were included, which involved 10,498 participants were included. Compared to AL, DHA-PQ was associated with a slightly higher frequency of early vomiting (RR 2.26, 95% CI 1.46 to 3.50; participants = 7796; studies = 10; I2 = 0%, high quality of evidence), cough (RR 1.06, 95% CI 1.01 to 1.11; participants = 8013; studies = 13; I2 = 0%, high quality of evidence), and diarrhoea (RR 1.16, 95% CI 1.03 to 1.31; participants = 6841; studies = 11; I2 = 8%, high quality of evidence) were more frequent in DHA-PQ treatment arm.ConclusionFrom this review, it can be concluded that early vomiting, diarrhoea, and cough were common were significantly more frequent in patients who were treated with the DHA-PQ than that of AL, and both drugs are well tolerated. More studies comparing AL with DHA-PQ are needed to determine the comparative safety of these drugs.

【 授权许可】

CC BY