Nakato Halima, Vivancos Roberto, Hunter Paul R
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK.
J Antimicrob Chemother. 2007 Nov;60(5):929-36. doi: 10.1093/jac/dkm337. Epub 2007 Sep 10.
A systematic review and meta-analysis of the effectiveness of atovaquone-proguanil (Malarone) as a chemoprophylactic agent against malaria.
The data sources searched for this study included Cochrane systematic reviews (on infectious diseases), MEDLINE and EMBASE, Web of Knowledge and Annals of Tropical Medicine. All unconfounded randomized controlled trials assessing the chemoprophylaxis against malaria with atovaquone-proguanil were included in the review. Data on study design, study sample, inclusion and exclusion criteria, allocation, blinding, primary and secondary study end points were all extracted by one reviewer and independently rechecked by the second reviewer.
In general, all 10 studies identified had excellent quality with total scores of >or=4 using the Jadad criteria. Ten controlled trials comprising 4,539 participants were included for this review. A meta-analysis of six of the ten studies found chemoprophylaxis with atovaquone-proguanil, with a prophylaxis efficacy of 95.8% (95% CI = 91.5-97.9), to be superior to placebo. It was also considered safe and better tolerated with fewer treatment-related adverse events that could lead to premature discontinuation of prophylaxis than in controls. Comparison with alternative chemoprophylaxis also showed atovaquone-proguanil to be better tolerated with fewer treatment-related self-reported adverse events (RR = 0.8234; 95% CI = 0.673164-1.01) or severe adverse events (RR = 0.6140; 95% CI = 0.420055-0.8975). Atovaquone-proguanil is well tolerated with no difference in non-compliance with placebo (RR = 0.8804; 95% CI = 0.6964-1.113; I(2) = 31.4%).
Evidence from this review shows that atovaquone-proguanil is highly efficacious as a prophylactic agent against malaria infection and is very well tolerated compared with other antimalarial agents.
对阿托伐醌-氯胍（malarone）作为疟疾化学预防药物的有效性进行系统评价和荟萃分析。
本研究检索的数据来源包括Cochrane系统评价（关于传染病）、MEDLINE和EMBASE、Web of Knowledge以及《热带医学年鉴》。所有评估阿托伐醌-氯胍预防疟疾的无混淆随机对照试验均纳入本评价。研究设计、研究样本、纳入和排除标准、分配、盲法、主要和次要研究终点的数据均由一名评价者提取，并由第二名评价者独立复查。
总体而言，使用Jadad标准，所有10项纳入研究的质量都很高，总分≥4分。本评价纳入了10项对照试验，共4539名参与者。对其中6项研究进行的荟萃分析发现，阿托伐醌-氯胍预防疟疾的效果优于安慰剂，预防有效率为95.8%（95%可信区间=91.5-97.9）。它也被认为是安全的，耐受性良好，与对照组相比，与治疗相关的不良事件较少，这些不良事件可能导致预防过早中断。与其他化学预防药物的比较也显示，阿托伐醌-氯胍耐受性更好，自我报告的与治疗相关的不良事件较少（相对危险度=0.8234；95%可信区间=0.673164-1.01）或严重不良事件较少（相对危险度=0.6140；95%可信区间=0.420055-0.8975）。阿托伐醌-氯胍耐受性良好，与安慰剂在不依从性方面无差异（相对危险度=0.8804；95%可信区间=0.6964-1.113；I²=31.4%）。
本评价的证据表明，阿托伐醌-氯胍作为预防疟疾感染的药物非常有效，与其他抗疟药物相比耐受性很好。
