Page 161 - 80 guidelines for the treatment of malaria_opt

ANNEX 7. Uncomplicated Plasmodium falciparum malaria

No serious indirectness: trials were conducted in Asia (Cambodia and Thailand) in areas of low and unstable transmission; children aged <1 year and pregnant or lactating women were excluded.

No serious limitations: allocation concealment was judged to be at “low risk of bias” in all trials reporting this outcome; laboratory staff were blinded in two of the trials.

Serious indirectness: only one trial, conducted in Peru in a low transmission setting; children aged <5 years and pregnant and lactating women were excluded.
Serious imprecision: the 95% CI of the pooled estimate includes appreciable benefit with DHA+PPQ over AS+MQ and no difference between the drugs.
In these trials, both drugs have total failure rates (PCR adjusted) at day 63 of less than 10% in line with WHO recommendations.
No serious imprecision: the 95% CI of the pooled estimate includes appreciable benefit with DHA+PPQ over AS+MQ and non-appreciable benefit.

Very serious imprecision: the 95% CI of the pooled estimate is wide including appreciable benefit or harm with each drug over the other.
Very serious imprecision: the 95% CI of the pooled estimate includes appreciable benefit or harm with both drugs over the other.

DHA+PPQ is at least as effective at treating P. falciparum as AS+MQ in Asia (high quality evidence).
Data on treatment failure at days 42 and 28 were also available and no differences between the two drugs were shown.
No serious limitations: allocation concealment was assessed as “low risk of bias”; no blinding was described in this trial.
No difference has been shown in the incidence of serious adverse events (low quality evidence).
No serious limitations: allocation concealment was judged to be at “low risk of bias” in seven out of eight trials.
No serious indirectness: trials conducted in Asia and South America in low and unstable transmission settings.
No serious imprecision: both limits of the 95% CI suggest appreciable benefit with AS+MQ over DHA+PPQ.
DHA+PPQ is not as effective on gametocytes as AS+MQ (high quality evidence).

Serious limitations: all trials were open label and judged to at “high risk of bias” for blinding.

A7

Cambodia (11) and Thailand (12, 13). No serious inconsistency: heterogeneity was low.

panel comment: panel conclusion: Peru (14).

11.
10.
16.
15.
14.
12.
13.
3.
4.
1.
2.
5.
8.
9.
6.
7.

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