基于青蒿素的联合疗法治疗马里无并发症恶性疟原虫疟疾：系统评价和荟萃分析。

Artemisinin-based combination therapy for uncomplicated Plasmodium falciparum malaria in Mali: a systematic review and meta-analysis.

机构信息

University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.

Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street #8310, Suite 1610, New Orleans, LA, 70112-2703, USA.

出版信息

Malar J. 2021 Aug 30;20(1):356. doi: 10.1186/s12936-021-03890-0.

BACKGROUND

Artemisinin-based combination therapy (ACT) was deployed in 2005 as an alternative to chloroquine and is considered the most efficacious treatment currently available for uncomplicated falciparum malaria. While widespread artemisinin resistance has not been reported to date in Africa, recent studies have reported partial resistance in Rwanda. The purpose of this study is to provide a current systematic review and meta-analysis on ACT at Mali study sites, where falciparum malaria is highly endemic.

METHODS

A systematic review of the literature maintained in the bibliographic databases accessible through the PubMed, ScienceDirect and Web of Science search engines was performed to identify research studies on ACT occurring at Mali study sites. Selected studies included trials occurring at Mali study sites with reported polymerase chain reaction (PCR)-corrected adequate clinical and parasite response rates (ACPRcs) at 28 days. Data were stratified by treatment arm (artemether-lumefantrine (AL), the first-line treatment for falciparum malaria in Mali and non-AL arms) and analysed using random-effects, meta-analysis approaches.

RESULTS

A total of 11 studies met the inclusion criteria, and a risk of bias assessment carried out by two independent reviewers determined low risk of bias among all assessed criteria. The ACPRc for the first-line AL at Mali sites was 99.0% (95% CI (98.3%, 99.8%)), while the ACPRc among non-AL treatment arms was 98.9% (95% CI (98.3%, 99.5%)). The difference in ACPRcs between non-AL treatment arms and AL treatment arms was not statistically significant (p = .752), suggesting that there are potential treatment alternatives beyond the first-line of AL in Mali.

CONCLUSIONS

ACT remains highly efficacious in treating uncomplicated falciparum malaria in Mali. Country-specific meta-analyses on ACT are needed on an ongoing basis for monitoring and evaluating drug efficacy patterns to guide local malaria treatment policies, particularly in the wake of observed artemisinin resistance in Southeast Asia and partial resistance in Rwanda.

背景

2005 年，青蒿素联合疗法（ACT）被作为氯喹的替代疗法投入使用，被认为是目前治疗无并发症恶性疟最有效的方法。虽然目前在非洲尚未报告广泛的青蒿素耐药性，但最近的研究报告称，卢旺达存在部分耐药性。本研究旨在对马里研究点进行当前的系统评价和荟萃分析，这些研究点恶性疟高度流行。

方法

通过检索 PubMed、ScienceDirect 和 Web of Science 搜索引擎中的文献数据库，对马里研究点发生的 ACT 研究进行系统评价。选择的研究包括在马里研究点进行的试验，这些试验报告了聚合酶链反应（PCR）校正后的充分临床和寄生虫反应率（ACPRcs）在 28 天。数据按治疗组（青蒿琥酯-咯萘啶（AL），马里治疗恶性疟的一线药物和非-AL 组）进行分层，并使用随机效应、荟萃分析方法进行分析。

结果

共有 11 项研究符合纳入标准，由两名独立审查员进行的风险偏倚评估确定了所有评估标准的低风险偏倚。马里研究点一线治疗的 ACPRc 为 99.0%（95%可信区间（98.3%，99.8%）），而非-AL 治疗组的 ACPRc 为 98.9%（95%可信区间（98.3%，99.5%））。非-AL 治疗组与 AL 治疗组的 ACPRc 差异无统计学意义（p=0.752），表明在马里，除了一线的 AL 之外，还有潜在的治疗替代方案。