Intervention Review

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

  1. Aika AA Omari1,*,
  2. Carrol L Gamble2,
  3. Paul Garner3

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 19 OCT 2005

Assessed as up-to-date: 17 AUG 2005

DOI: 10.1002/14651858.CD005564


How to Cite

Omari AAA, Gamble CL, Garner P. Artemether-lumefantrine (six-dose regimen) for treating uncomplicated falciparum malaria. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005564. DOI: 10.1002/14651858.CD005564.

Author Information

  1. 1

    Alder Hey Children's Hospital, Liverpool, UK

  2. 2

    University of Liverpool, Centre for Medical Statistics and Health Evaluation, Liverpool, UK

  3. 3

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

*Aika AA Omari, Alder Hey Children's Hospital, Eaton Road, Liverpool, L12 2AP, UK. aomari@nhs.net. aika@omari1677.freeserve.co.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 OCT 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Using a pilot system we have categorised this review as: Current question - no update intended (topic covered in another review. Refer to: Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin-based combination therapy for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2.) Please see "Published notes" section of the review for more details.

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 methods

We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL (The Cochrane Library 2005, Issue 1), 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 the risk of bias in the trials, 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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

Using a pilot system we have categorised this review as: Current question - no update intended (topic covered in another review. Refer to: Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin-based combination therapy for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2.) Please see "Published notes" section of the review for more details.

Malaria is a parasitic disease, spread by mosquitoes. It affects millions of people worldwide, and causes significant illness and mortality. Uncomplicated malaria presents with symptoms such as fever, headache, muscle pain, and vomiting. The parasite has become resistant to a number of previously effective drugs, and so combinations of drugs are used to try increase cure and to prevent further resistance. Artemether-lumefantrine is one such drug combination. This review of trials showed that the six-dose regimen of artemether-lumefantrine was associated with high cure rates and was more effective that most other drug combinations used for uncomplicated malaria. Further research is needed to properly assess adverse outcomes.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用於治療非重症惡性瘧疾之Artemetherlumefantrine (6劑療程)

世界衛生組織(The World Health Organization)建議使用artemetherlumefantrine治療非重症瘧疾。茲尋求證據說明6劑處方優於既有處方,並說明其在臨床上之有效性。

目標

評估用於治療非重症惡性瘧疾之6劑療程artemetherlumefantrine

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2005年4月)、 CENTRAL (Cochrane Library 2005, Issue 1)、 MEDLINE (1966年−2005年4月)、 EMBASE (1974年−2005年4月)、 LILACS (1982年−2005年4月)、研討會手冊,以及文章的參考資料清單.。我們也與瘧疾研究專家及製造artemetherlumefantrine的藥廠聯繫。

選擇標準

對於非重症惡性瘧疾,比較口服投與之6劑 artemetherlumefantrine與標準治療處方(單一藥物或組合),或是比較受指導監督與未受指導監督之治療,之隨機對照試驗。

資料收集與分析

由2名作者獨立對潛在相關之試驗應用收錄標準,評估試驗品質,並摘錄數據,包括不良作用。第28天之完全失敗率為首要結果(就sulfadoxinepyrimethamine為第42天而就mefloquine為第63天)。

主要結論

共有9項試驗(4547名參與者)檢驗該6劑療程。Artemetherlumefantrine在第28天之完全失敗率低於amodiaquine (270名參與者,1項試驗)、amodiaquine加sulfadoxinepyrimethamine (507名參與者,1項試驗),但高於chloroquine加sulfadoxinepyrimethamine (201名參與者,2項試驗)。相較於artemisinin衍生物之組合,artemetherlumefantrine之表現優於amodiaquine加artesunate (668名參與者,2項試驗),不如mefloquine加artesunate (270名參與者,4項試驗),並與dihydroartemisininnapthoquinetrimethoprim無差異(89名參與者,1項試驗)。

作者結論

Artemetherlumefantrine 6劑之處方療程明顯較不含 artemisinin 衍生物之抗瘧疾療程更為有效。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

用於治療非重症惡性瘧疾之Artemetherlumefantrine (6劑處方療程)。瘧疾是一種由蚊子傳播之寄生蟲疾病。其影響全世界數以百萬計的人並造成重大之疾病及死亡。非重症瘧疾具有諸如發燒、頭痛、肌肉痛、及嘔吐之症狀。瘧疾寄生蟲已對諸多先前有效之藥物產生抗藥性,因此目前多使用藥物之組合以嘗試增加治癒率並防止產生進一步之抗藥性。Artemetherlumefantrine是其中一種此類之藥物組合。本試驗回顧顯示,artemetherlumefantrine之6劑療程具有高治癒率,且其較用於治療非重症瘧疾之大部分其他藥物組合更為有效。仍有需要進一步之研究以適當評估不良結果。