Intervention Review

Artemether-lumefantrine (four-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 APR 2006

Assessed as up-to-date: 19 JAN 2006

DOI: 10.1002/14651858.CD005965


How to Cite

Omari AAA, Gamble CL, Garner P. Artemether-lumefantrine (four-dose regimen) for treating uncomplicated falciparum malaria. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005965. DOI: 10.1002/14651858.CD005965.

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: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 19 APR 2006

SEARCH

 

Abstract

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

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 methods

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.

2008: This review will not be updated because the four-dose regimen is no longer recommended; see 'What's new' for details.

 

Plain language summary

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

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

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 to prevent further resistance. Artemether-lumefantrine is one such drug combination. This review of trials showed that, although the four-dose artemether-lumefantrine regimen was superior to chloroquine, in general the four-dose regimen was less effective compared with the six-dose regimen or other drug combinations. The fact that the four-dose regimen is generally less effective means it is unlikely that it would be used for treating uncomplicated malaria.

 

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 (4劑療程)

世界衛生組織(The World Health Organization)建議使用一種昂貴之藥物artemetherlumefantrine作為非重症瘧疾之治療。茲尋求證據說明4劑療程優於既有療程。

目標

評估用於治療非重症惡性瘧疾之4劑療程artemetherlumefantrine。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2005年10月)、 CENTRAL (Cochrane Library 2005, Issue 3)、 MEDLINE (1966年−2005年10月)、 EMBASE (1988年 – 2005年10月)、 LILACS (1982年 – 2005年10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

比較4劑 artemetherlumefantrine與標準治療流程(單一藥物或組合),或是比較其與6劑 artemetherlumefantrine,對於治療非重症惡性瘧疾的隨機對照試驗。

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7項試驗(2057名參與者)檢驗該4劑療程。相較於其他藥物,使用 artemetherlumefantrine 造成較多之治療失敗結果,此等其他藥物包括sulfadoxinepyrimethamine (247名參與者,1項試驗)、halofantrine (86名參與者,1項試驗)、及mefloquine (233名參與者,1項試驗; mefloquine之差異具統計顯著性)。相較於chloroquine,artemetherlumefantrine在其中2項試驗(378名參與者)有較佳表現,但超過50%接受chloroquine治療之參與者在第28天治療完全失敗。相較於4劑療程,接受6劑療程者具有較少之治療失敗情形(RR 7.71, 95% CI 2.99 to 19.88; 306名參與者,1項試驗)。

作者結論

Artemetherlumefantrine之4劑療程似乎不如與其進行比較試驗之其他藥劑處方般有效。6劑療程優於4劑療程。

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 (4劑療程)。瘧疾是一種由蚊子傳播之寄生蟲性疾病。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,儘管artemetherlumefantrine之4劑療程優於 chloroquine,一般而言,4劑artemetherlumefantrine之療程不如6劑療程或是其他藥物組合般有效。此種4劑療程效力較低之事實意謂其不太可能可用於治療非重症瘧疾。