McIntosh H M, Olliaro P
Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK, L3 5QA.
Cochrane Database Syst Rev. 2000;1999(2):CD000256. doi: 10.1002/14651858.CD000256.
Artemisinin derivatives are a relatively new group of drugs with antimalarial properties. As resistance to other antimalarial drugs continues to increase, artemisinin drugs may be useful alternatives.
The objective of this review was to assess the effects of artemisinin drugs for treating uncomplicated falciparum malaria.
We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, Science Citation Index, Lilacs, African Index Medicus; conference abstracts and reference lists of relevant articles. We contacted organisations, researchers in the field and drug companies.
Randomised and quasi-randomised trials of artemisinin derivatives, alone or in combination with other antimalarials, compared with standard antimalarial treatments, in adults or children with uncomplicated falciparum malaria. Only trials where treatment was given by mouth or suppository were included. Comparisons between different artemisinin derivatives and treatment regimens were also included.
Eligibility and trial quality were assessed and data were extracted independently by the two reviewers.
Forty-one trials involving over 5000 patients were included. Variation in study design and quality made synthesis of the data problematic. Allocation concealment was adequate in only two trials. Most data were from areas of multidrug resistant falciparum malaria in South East Asia. Compared with standard antimalarial treatments, artemisinin drugs showed fast parasite clearance and high cure rates at follow-up, provided the duration of treatment with artemisinin drugs was adequate. Combination with mefloquine improved sustained parasite clearance and was effective in multidrug resistant areas. When doses were adequate, the combination shortened the duration of treatment. We found no evidence that artemisinin drugs are more harmful than standard treatment drugs over a typical trial period of 28 days.
REVIEWER'S CONCLUSIONS: The evidence suggests that artemisinin drugs are effective and safe for treating uncomplicated malaria. There is no evidence from randomised trials that one artemisinin derivative is better than the others. In areas where there is mefloquine resistance, combination therapy with an artemisinin derivative appears to improve sustained parasite clearance compared with either drug alone.
青蒿素衍生物是一类相对较新的具有抗疟特性的药物。随着对其他抗疟药物的耐药性持续增加，青蒿素类药物可能是有用的替代药物。
本综述的目的是评估青蒿素类药物治疗非复杂性恶性疟的效果。
我们检索了Cochrane传染病组试验注册库、Cochrane对照试验注册库、Medline、Embase、科学引文索引、Lilacs、非洲医学索引；会议摘要以及相关文章的参考文献列表。我们联系了相关组织、该领域的研究人员和制药公司。
在患有非复杂性恶性疟的成人或儿童中，将青蒿素衍生物单独或与其他抗疟药联合使用，与标准抗疟治疗进行比较的随机和半随机试验。仅纳入通过口服或栓剂给药的试验。还包括不同青蒿素衍生物和治疗方案之间的比较。
两名评价员独立评估纳入标准和试验质量并提取数据。
纳入了41项涉及5000多名患者的试验。研究设计和质量的差异使得数据合成存在问题。只有两项试验的分配隐藏充分。大多数数据来自东南亚多药耐药恶性疟地区。与标准抗疟治疗相比，青蒿素类药物在随访时显示出快速的寄生虫清除率和高治愈率，前提是青蒿素类药物的治疗持续时间足够。与甲氟喹联合使用可提高寄生虫的持续清除率，并且在多药耐药地区有效。当剂量足够时，联合用药缩短了治疗时间。在28天的典型试验期内，我们没有发现证据表明青蒿素类药物比标准治疗药物更有害。
证据表明，青蒿素类药物治疗非复杂性疟疾有效且安全。随机试验没有证据表明一种青蒿素衍生物比其他衍生物更好。在存在甲氟喹耐药性的地区，与单独使用任何一种药物相比，青蒿素衍生物联合疗法似乎能提高寄生虫的持续清除率。
