Evidence map›Paper›PMID 27865890›Full record

SynthesisThe Lancet. Infectious diseases2017

Safety, tolerability, and efficacy of repeated doses of dihydroartemisinin-piperaquine for prevention and treatment of malaria: a systematic review and meta-analysis.

Julie Gutman, Stephanie Kovacs, Grant Dorsey, Andy Stergachis, Feiko O Ter Kuile

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04844099 (Dihydroartemisinin-Piperaquine or Sulphadoxine-Pyrimethamine for the Chemoprevention of Malaria in Children With Sickle Cell Anaemia in Eastern and Southern Africa), which is not on this map. Cited by 68 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 7 pooled it
9.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04844099 phase3completednot on this mapstarted 2021, after this paper: background citation

Dihydroartemisinin-Piperaquine or Sulphadoxine-Pyrimethamine for the Chemoprevention of Malaria in Children With Sickle Cell Anaemia in Eastern and Southern Africa: a Double Blind Randomised Trial (CHEMCHA)

TypeinterventionalSponsorLiverpool School of Tropical MedicineRan2021 to 2023Enrolled723ConditionsSickle Cell Anemia in Children, MalariaArmsDihydroartemisinin Piperaquine
3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 7 syntheses or guidelines pooled it, 110 citations in OpenAlex.

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  15. Piperaquine-Induced QTc Prolongation Decreases With Repeated Monthly Dihydroartemisinin-Piperaquine Dosing in Pregnant Ugandan Women.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022
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  17. Dihydroartemisinin-Piperaquine Chemoprevention and Malaria Incidence After Severe Flooding: Evaluation of a Pragmatic Intervention in Rural Uganda.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022
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8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 2 countries.

Julie GutmanMalaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: fff2@cdc.gov.
Stephanie KovacsDepartment of Epidemiology, University of Washington, Seattle, WA, USA.
Grant DorseyDepartment of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
Andy StergachisDepartment of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA.
Feiko O Ter KuileLiverpool School of Tropical Medicine, Liverpool, UK.
University of Washington · USCenters for Disease Control and Prevention · USLiverpool School of Tropical Medicine · GBSan Francisco General Hospital · US

Funding

NRSA Training CoreTL1TR002318 · NCATS · UNIVERSITY OF WASHINGTON · PI Megan Moore · 2017 to 2026
$8.4M
Institute of Translational Health SciencesTL1TR000422 · NCATS · UNIVERSITY OF WASHINGTON · PI DISIS, MARY L. · 2012 to 2016
$2.1M
Medical Research Council MC_PC_MR/P006914/1NCATS NIH HHS TL1 TR000422NCATS NIH HHS TL1 TR002318
6 · The paper itself

Abstract

backgroundIntermittent preventive treatment (IPT) for malaria is used in infants, children, adults, and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. We conducted a systematic review and meta-analysis to establish the efficacy and safety of repeated treatment with DP.

methodsFollowing PRISMA guidelines, we searched multiple databases on Sept 1, 2016, with the terms: "human" AND "dihydroartemisinin-piperaquine" OR "DHA-PPQ". Studies were eligible if they were randomised controlled trials (RCTs) or prospective cohort studies involving repeat exposures to standard 3-day courses of DP for either seasonal malaria chemoprevention, mass drug administration, or treatment of clinical malaria, conducted at any time and in any geographic location. Random-effects meta-analysis was used to generate pooled incidence rate ratios and relative risks, or risk differences.

findings11 studies were included: two repeat treatment studies (one in children younger than 5 years and one in pregnant women), and nine IPT trials (five in children younger than 5 years, one in schoolchildren, one in adults, two in pregnant women). Comparator interventions included placebo, artemether-lumefantrine, sulfadoxine-pyrimethamine (SP), SP+amodiaquine, SP+piperaquine, SP+chloroquine, and co-trimoxazole. Of 14 628 participants, 3935 received multiple DP courses (2-18). Monthly IPT-DP was associated with an 84% reduction in the incidence of malaria parasitaemia measured by microscopy compared with placebo. Monthly IPT-DP was associated with fewer serious adverse events than placebo, daily co-trimoxazole, or monthly SP. Among 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP.

interpretationMonthly DP appears well tolerated and effective for IPT. Additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing.

fundingBill & Melinda Gates Foundation and NIH.

Indexed as

AntimalarialsArtemisininsDrug CombinationsDrug Therapy, CombinationHumansMalariaPiperazinesPyrimethamineQuinolinesRandomized Controlled Trials as TopicSulfadoxineAntimalarialsArtemisininsartenimolDrug Combinationsfanasil, pyrimethamine drug combinationpiperaquinePiperazinesPyrimethamineQuinolinesSulfadoxine

Identifiers

PMID27865890
PMCPMC5266794
OpenAlexW2555838895

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.