Wang Qi, Zou Yuanyuan, Pan Ziyi, Zhang Hongying, Deng Changsheng, Yuan Yueming, Guo Jiawen, Tang Yexiao, Julie Nadia, Wu Wanting, Li Guoming, Li Mingqiang, Tan Ruixiang, Huang Xinan, Guo Wenfeng, Li Changqing, Xu Qin, Song Jianping
Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
Institute of Science and Technology, Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Pharmacol. 2020 Sep 11;11:562363. doi: 10.3389/fphar.2020.562363. eCollection 2020.
The World Health Organization recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria to improve the therapeutic efficacy and limit the choice of drug-resistant parasites. This systematic review and meta-analysis aimed to evaluate the comparative efficacy and safety of artemisinin-piperaquine (AP) in the treatment of uncomplicated malaria relative to other commonly used ACTs.
As per the PRISMA guidelines, the EMBASE, MEDLINE, the Google Scholar Library, and Cochrane library databases were systematically searched from inception until July 2020 with the following terms: "artemisinin-piperaquine" or "AP." Only randomized controlled trials (RCTs) were included. The competing interventions included dihydroartemisinin-piperaquine (DHA-PPQ), artemether-lumefantrine (AL, Coartem), artesunate-melfloquine (ASAM) and artesunate-amodiaquine (ASAQ, Artekin). Single-arm clinical trial on AP was also assessed. The reported outcomes, including the overall response, cure rate, fever and parasite clearance time, hematology, biochemistry, electrocardiogram (ECG), adverse events, recurrence rate, and sensitivity analyses, were systematically investigated. All data were analyzed using the Review Manager 5.3.
A total of seven studies were reviewed, including five RCTs and two single-arm studies. A pooled analysis of 5 RCTs (n = 772) revealed a comparable efficacy on polymerase chain reaction (PCR)-confirmed cure rate between AP and competing interventions in treating uncomplicated malaria. As for the fever and parasite clearance time, due to the lack of complete data in some studies, only 3 studies' data could be used. The patients showed good tolerance to all drugs, and some side-effects (such as headache, anoxia, vomiting, nausea, and dizziness) were reported for every group, but they were self-limited and showed no significant difference.
AP appeared to show similar efficacy and safety, with a simpler mode of administration and easier compliance when compared with other ACTs used in the treatment of uncomplicated malaria. Considering that the potential evolution of drug resistance is of a great concern, additional RCTs with high-quality and more rigorous design are warranted to substantiate the efficacy and safety in different populations and epidemiological regions.
世界卫生组织推荐以青蒿素为基础的联合疗法（ACTs）用于治疗非复杂性疟疾，以提高治疗效果并限制耐药寄生虫的选择。本系统评价和荟萃分析旨在评估青蒿素哌喹（AP）与其他常用ACTs相比，治疗非复杂性疟疾的疗效和安全性。
按照PRISMA指南，从建库至2020年7月，对EMBASE、MEDLINE、谷歌学术库和Cochrane图书馆数据库进行系统检索，检索词如下：“青蒿素哌喹”或“AP”。仅纳入随机对照试验（RCTs）。对照干预措施包括双氢青蒿素哌喹（DHA-PPQ）、蒿甲醚苯芴醇（AL，科泰复）、青蒿琥酯甲氟喹（ASAM）和青蒿琥酯阿莫地喹（ASAQ，阿特金）。还评估了关于AP的单臂临床试验。系统研究报告的结局，包括总体反应、治愈率、发热和寄生虫清除时间、血液学、生物化学、心电图（ECG）、不良事件、复发率和敏感性分析。所有数据均使用Review Manager 5.3进行分析。
共纳入7项研究，包括5项RCTs和2项单臂研究。对5项RCTs（n = 772）的汇总分析显示，在治疗非复杂性疟疾方面，AP与对照干预措施在聚合酶链反应（PCR）确诊的治愈率上疗效相当。至于发热和寄生虫清除时间，由于部分研究数据不完整，仅能使用3项研究的数据。患者对所有药物耐受性良好，每组均报告了一些副作用（如头痛、缺氧、呕吐、恶心和头晕），但这些副作用为自限性，且无显著差异。
与用于治疗非复杂性疟疾的其他ACTs相比，AP似乎具有相似的疗效和安全性，给药方式更简单，依从性更好。鉴于耐药性的潜在演变备受关注，有必要开展更多高质量、设计更严谨的RCTs，以证实其在不同人群和流行地区的疗效和安全性。
