| Title: |
Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data |
| Authors: |
Abdulla, S; Adam, I; Adjei, G; Adjuik, M; Alemayehu, B; Allan, R; Arinaitwe, E; Ashley, E; Ba, MS; Barennes, H; Barnes, K; Bassat, Q; Baudin, E; Berens-Riha, N; Bjoerkman, A; Bompart, F; Bonnet, M; Borrmann, S; Bousema, T; Brasseur, P; Bukirwa, H; Checchi, F; Dahal, P; D'Alessandro, U; Desai, M; Dicko, A; Djimde, A; Dorsey, G; Doumbo, O; Drakeley, C; Duparc, S; Eshetu, T; Espie, E; Etard, J; Faiz, A; Falade, C; Fanello, C; Faucher, J; Faye, B; Faye, O; Filler, S; Flegg, J; Fofana, B; Fogg, C; Gadalla, N; Gaye, O; Genton, B; Gething, P; Gil, J; Gonzalez, R; Grandesso, F; Greenhouse, B; Greenwood, B; Grivoyannis, A; Guerin, P; Guthmann, J; Hamed, K; Hamour, S; Hay, S; Hodel, E; Humphreys, G; Hwang, J; Ibrahim, M; Jima, D; Jones, J; Jullien, V; Juma, E; Kachur, P; Kager, P; Kamugisha, E; Kamya, MR; Karema, C; Kayentao, K; Kiechel, J; Kironde, F; Kofoed, P; Kremsner, P; Krishna, S; Lameyre, V; Lell, B; Lima, A; Makanga, M; Malik, E; Marsh, K; Martensson, A; Massougbodji, A; Menan, H; Menard, D; Menendez, C; Mens, P; Meremikwu, M; Moreira, C; Nabasumba, C; Nambozi, M; Ndiaye, J; Ngasala, B; Nikiema, F; Nsanzabana, C; Ntoumi, F; Oguike, M; Ogutu, B; Olliaro, P; Omar, SA; Ouedraogo, J; Owusu-Agyei, S; Penali, L; Pene, M; Peshu, J; Piola, P; Plowe, C; Premji, Z; Price, R; Randrianarivelojosia, M; Rombo, L; Roper, C; Rosenthal, P; Sagara, I; Same-Ekobo, A; Sawa, P; Schallig, H; Schramm, B; Seck, A; Shekalaghe, SA; Sibley, C; Sinou, V; Sirima, S; Som, F; Sow, D; Staedke, S; Stepniewska, K; Sutherland, C; Swarthout, T; Sylla, K; Talisuna, A; Taylor, W; Temu, E; Thwing, J; Tine, R; Tinto, H; Tommasini, S; Toure, O; Ursing, J; Vaillant, M; Valentini, G; Van den Broek, I; Van Vugt, M; Ward, SA; Winstanley, P; Yavo, W; Yeka, A; Zolia, Y; Zongo, I; Based, W |
| Publisher Information: |
BioMed Central |
| Publication Year: |
2016 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Background: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). Methods: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. Results: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P 37.5 °C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with ... |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| DOI: |
10.1186/s12916-015-0445-x |
| Availability: |
https://doi.org/10.1186/s12916-015-0445-x; https://ora.ox.ac.uk/objects/uuid:7327928a-fc83-4ebc-9ebd-608e0da942b4 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.8FEB5314 |
| Database: |
BASE |