Peixoto Henry Maia, Marchesini Paola Barbosa, de Oliveira Maria Regina Fernandes
Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil
University Centre of Brasília, Brasília, Federal District, Brazil.
Trans R Soc Trop Med Hyg. 2016 Nov;110(11):626-636. doi: 10.1093/trstmh/trw077. Epub 2016 Dec 29.
The present study is a systematic review of the literature on the efficacy and safety of the treatment of uncomplicated Plasmodium falciparum infections with artesunate-mefloquine (ASMQ) compared to other artemisinin-based combination therapies (ACTs), designed to assist decision makers in Brazil.
Twenty-four randomized controlled trials (RCTs) were selected in four electronic databases and in complementary sources. Meta-analyses were performed to evaluate the efficacy expressed by relative risks (RR) obtained from treatment failure confirmed by the PCR.
Due primarily to the presence of measurement bias in the selected studies, the quality of the evidence was considered predominantly moderate. Statistically significant associations were not observed when ASMQ was compared to artemether-lumefentrine and dihydroartemisinin-piperaquine. The results of studies performed in areas with a history of use of ASMQ, regardless of the intensity of transmission, were not statistically different from those presented in the meta-analyses. For comparisons with artesunate-amodiaquine and artesunate+sulfadoxine-pyrimethamine, the results were favourable to ASMQ. No deaths were attributed to ASMQ, severe adverse events were rare and some studies indicate a higher frequency of mild adverse events.
The use of ASMQ it is recommended to Brazil as first line treatment of uncomplicated P. falciparum infections.
本研究是一项关于青蒿琥酯-甲氟喹（ASMQ）与其他基于青蒿素的联合疗法（ACTs）治疗单纯性恶性疟原虫感染的疗效和安全性的文献系统评价，旨在为巴西的决策者提供帮助。
在四个电子数据库和补充资料来源中筛选出24项随机对照试验（RCTs）。进行荟萃分析以评估通过PCR确认的治疗失败所获得的相对风险（RR）表示的疗效。
主要由于所选研究中存在测量偏倚，证据质量主要被认为是中等的。将ASMQ与蒿甲醚-本芴醇和双氢青蒿素-哌喹进行比较时，未观察到统计学上的显著关联。在有ASMQ使用史的地区进行的研究结果，无论传播强度如何，与荟萃分析中的结果在统计学上无差异。与青蒿琥酯-阿莫地喹和青蒿琥酯+磺胺多辛-乙胺嘧啶进行比较时，结果有利于ASMQ。没有死亡归因于ASMQ，严重不良事件很少见，一些研究表明轻度不良事件的发生率较高。
建议在巴西将ASMQ用作单纯性恶性疟原虫感染的一线治疗药物。
