The efficacy and safety of intermittent preventive treatment with sulphadoxine-pyrimethamine vs artemisinin-based drugs for malaria: a systematic review and meta-analysis

Xiajing Chu; Peijing Yan; Na Zhang; Nan Chen; Yang Liu; Lufang Feng; Meixuan Li; Ziyao Zhang; Qi Wang; Shizhong Wang; Kehu Yang

doi:10.1093/trstmh/trab158

The efficacy and safety of intermittent preventive treatment with sulphadoxine-pyrimethamine vs artemisinin-based drugs for malaria: a systematic review and meta-analysis

Trans R Soc Trop Med Hyg. 2022 Apr 4;116(4):298-309. doi: 10.1093/trstmh/trab158.

Authors

Xiajing Chu^{1

2

3

4}, Peijing Yan⁵, Na Zhang^{1

2

3

4}, Nan Chen^{1

2

3

4}, Yang Liu⁶, Lufang Feng^{1

2

3

4}, Meixuan Li^{1

2

3

4}, Ziyao Zhang⁷, Qi Wang^{8

9

10}, Shizhong Wang¹¹, Kehu Yang^{1

2

3

4}

Affiliations

¹ Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
² Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou,730000, China.
³ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
⁴ Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
⁵ Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, China.
⁶ Institute for Health Toxicology, School of Public Health, Lanzhou University, Lanzhou,730000, China.
⁷ School of Foreign Language, Lanzhou University of Arts and Science, Lanzhou, 730000, China.
⁸ Health Policy PhD Program, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.
⁹ McMaster Health Forum, McMaster University, Hamilton, Ontario, L8S 4L6, Canada.
¹⁰ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.
¹¹ Wuwei People's Hospital, Wuwei, 733000, China.

PMID: 34651193
DOI: 10.1093/trstmh/trab158

Abstract

Background: Malaria is one of the most serious global problems. The objective of this study is to assess whether intermittent preventive treatment (IPT) using artemisinin-based combination therapies (ACTs) was a promising alternative to IPT with sulphadoxine-pyrimethamine (IPT-SP).

Methods: We searched the following sources up to 12 August 2020: PubMed, The Cochrane Library, Embase, Web of Science, CNKI, CBM, VIP and WanFang Database from inception. The randomized controlled trials comparing SP with ACTs for malaria were included. Data were pooled using Stata.14 software. We performed subgroup analysis based on the different types of ACTs groups and participants.

Results: A total of 13 studies comprising 5180 people were included. The meta-analysis showed that ACTs had the lower risk of number of any parasitemia (RR=0.46; 95% CI 0.22 to 0.96, p=0.039; I2=90.50%, p<0.001), early treatment failure (RR=0.17; 95% CI 0.06 to 0.48, p<0.001; I2=66.60%, p=0.011) and late treatment failure (RR=0.34; 95% CI 0.13 to 0.92, p<0.001; I2=87.80%, p<0.001) compared with SP. There was no significant difference in adequate clinical response, average hemoglobin and adverse neonatal outcomes.

Conclusion: Combinations with ACTs appear promising as suitable alternatives for IPT-SP.

Keywords: artemisinin-based combination therapies; malaria; meta-analysis; sulfadoxine-pyrimethamine; sulfadoxine-pyrimethamine-artesunate; systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Antimalarials* / adverse effects
Artemisinins* / therapeutic use
Drug Combinations
Humans
Infant, Newborn
Malaria* / drug therapy
Malaria* / prevention & control
Malaria, Falciparum* / drug therapy
Malaria, Falciparum* / prevention & control
Pyrimethamine
Sulfadoxine / adverse effects

Substances

Antimalarials
Artemisinins
Drug Combinations
fanasil, pyrimethamine drug combination
Sulfadoxine
Pyrimethamine