Efficacy and safety of dihydroartemisinin-piperaquine for treatment of Plasmodium vivax malaria in endemic countries: meta-analysis of randomized controlled studies

• Published in: PloS one Vol. 8; no. 12; p. e78819
• Main Authors: Naing, Cho, Racloz, Vanessa, Whittaker, Maxine Anne, Aung, Kyan, Reid, Simon Andrew, Mak, Joon Wah, Tanner, Marcel
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.12.2013; Public Library of Science (PLoS)
• Subjects: Antimalarials; Antimalarials - adverse effects; Antimalarials - therapeutic use; Artemether; Artemisinin; Artemisinins - adverse effects; Artemisinins - therapeutic use; Chloroquine; Clinical trials; Complications and side effects; Demographic aspects; Dihydroartemisinin; Dosage and administration; Drug development; Drug dosages; Drug therapy; Drug Therapy, Combination - adverse effects; Drug Therapy, Combination - methods; Drugs; Effectiveness; Female; Humans; Infections; Malaria; Malaria, Vivax - drug therapy; Malaria, Vivax - epidemiology; Male; Meta-analysis; Multivariate analysis; Parasites; Plasmodium vivax; Population; Primaquine; Quality; Quantitative analysis; Quinolines - adverse effects; Quinolines - therapeutic use; Randomization; Randomized Controlled Trials as Topic; Safety; Slopes; Studies; Therapy; Vector-borne diseases; Switzerland; Malaysia; Kuala Lumpur Malaysia; Myanmar (Burma)
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0078819

This study aimed to synthesize available evidence on the efficacy of dihydroartemisinin-piperaquine (DHP) in treating uncomplicated Plasmodium vivax malaria in people living in endemic countries. This is a meta-analysis of randomized controlled trials (RCT). We searched relevant studies in electronic databases up to May 2013. RCTs comparing efficacy of (DHP) with other artemisinin-based combination therapy (ACT), non-ACT or placebo were selected. The primary endpoint was efficacy expressed as PCR-corrected parasitological failure. Efficacy was pooled by hazard ratio (HR) and 95% CI, if studies reported time-to-event outcomes by the Kaplan-Meier method or data available for calculation of HR Nine RCTs with 14 datasets were included in the quantitative analysis. Overall, most of the studies were of high quality. Only a few studies compared with the same antimalarial drugs and reported the outcomes of the same follow-up duration, which created some difficulties in pooling of outcome data. We found the superiority of DHP over chloroquine (CQ) (at day > 42-63, HR:2.33, 95% CI:1.86-2.93, I (2): 0%) or artemether-lumefentrine (AL) (at day 42, HR:2.07, 95% CI:1.38-3.09, I (2): 39%). On the basis of GRADE criteria, further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Findings document that DHP is more efficacious than CQ and AL in treating uncomplicated P. vivax malaria. The better safety profile of DHP and the once-daily dosage improves adherence, and its fixed co-formulation ensures that both drugs (dihydroartemisinin and piperaquine) are taken together. However, DHP is not active against the hypnozoite stage of P. vivax. DHP has the potential to become an alternative antimalarial drug for the treatment uncomplicated P. vivax malaria. This should be substantiated by future RCTs with other ACTs. Additional work is required to establish how best to combine this treatment with appropriate antirelapse therapy (primaquine or other drugs under development).