@article{fdi:010070933,
  title = {{C}omparison of anti-malarial drugs efficacy in the treatment of uncomplicated malaria in {A}frican children and adults using network meta-analysis},
  author = {{Y}oudom, {S}. {W}. and {T}ahar, {R}achida and {B}asco, {L}eonardo},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {A}rtemisinin-based combination therapy ({ACT}) and novel drug combinations are available and used in {A}frican countries to treat uncomplicated malaria. {N}etwork meta-analysis methods are rarely and poorly applied for the comparison of their efficacies. {T}his method was applied on a set of randomized controlled trials to illustrate its usefulness. {M}ethods: {A} literature review available in {P}ubmed was conducted in {J}uly 2016. {E}ligible studies, conducted in sub-{S}aharan {A}frica, published between 2002 and 2016, focused on randomized controlled trials of at least two artemisinin-based combinations to treat uncomplicated malaria in children and adults. {A}gglomerate data were: the number of {PCR}-corrected adequate clinical and parasitological response ({ACPR}) on day 28, used as the primary en{DHAP}oint in all interventions, the number of participants and the list of treatments. {A} {B}ayesian random effect meta-analysis using a binary outcome was the method to compare the efficacy. {R}anking measure was used to obtain a hierarchy of the competing interventions. {R}esults: {I}n total, 76 articles were included; 13 treatment regimens were involved and tested in 36,001 patients. {U}sing artemether-lumefantrine ({AL}) as the common comparator for the entire network, 12 relative treatment effects were estimated and indirect comparisons were obtained. {D}ihydroartemisinin-piperaquine ({DHAP}) was shown to be more effective than {AL} (odds ratio [{OR}] = 1.92; 95% {CI} 1.30-2.82; 19,163 patients), {ASAQ} ({OR} = 1.70; 95% {CI} 1.10-2.64; 14,433 patients), and amodiaquine-sulfadoxine-pyrimethamine ({AQSP}): {OR} = 2.20; 95% {CI} 1.21-3.96; 8863 patients. {A}rtesunate-amodiaquine ({ASAQ}) was comparable to {AL} ({OR} = 1.11; 95% {CI} 0.84-1.45; 21,235 patients). {N}o significant difference was found between artesunate and mefloquine ({ASMQ}) and {AL} ({OR} = 1.20; 95% {CI} = 0.52-2.8; 13,824 participants). {A}ccording to treatment ranking, among the {WHO}-recommended {ACT} medicines, {DHAP} was shown to be the most efficacious. {C}onclusions: {B}ased on the available evidence, this study demonstrated the superiority of {DHAP} among currently recommended artemisinin-based combinations. {T}he application of the methods described here may be helpful to gain better understanding of treatment efficacy and improve future decisions. {H}owever, more data are needed to allow robust conclusions about the results in comparison with novel drugs. {F}urther surveillance of the efficacy of anti-malarial drugs and clinical trials are needed to closely follow the evolution of the epidemiology of drug-resistant malaria in {A}frica.},
  keywords = {{P}lasmodium falciparum ; {A}nti-malarial drug ; {D}rug resistance ; {C}linical efficacy ; {B}ayesian modelling ; {M}ultiple treatment meta-analysis ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{M}alaria {J}ournal},
  volume = {16},
  numero = {},
  pages = {art. 311 [14 p.]},
  ISSN = {1475-2875},
  year = {2017},
  DOI = {10.1186/s12936-017-1963-0},
  URL = {https://www.documentation.ird.fr/hor/fdi:010070933},
}