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. 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. 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. 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.

中文翻译：

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马里基于青蒿素的联合疗法治疗无并发症的恶性疟原虫疟疾：系统评价和荟萃分析


基于青蒿素的联合疗法 (ACT) 于 2005 年作为氯喹的替代品被采用，被认为是目前治疗无并发症的恶性疟疾的最有效的治疗方法。虽然迄今为止非洲尚未报道广泛的青蒿素耐药性，但最近的研究报告了卢旺达的部分耐药性。本研究的目的是对恶性疟疾高度流行的马里研究地点的 ACT 进行当前的系统回顾和荟萃分析。对可通过 PubMed、ScienceDirect 和 Web of Science 搜索引擎访问的书目数据库中维护的文献进行了系统回顾，以确定在马里研究地点进行的 ACT 研究。选定的研究包括在马里研究地点进行的试验，报告聚合酶链反应 (PCR) 在 28 天时校正了足够的临床和寄生虫反应率 (ACPRcs)。数据按治疗组（蒿甲醚-本芴醇 (AL)，马里和非 AL 组治疗恶性疟的一线药物）进行分层，并使用随机效应、荟萃分析方法进行分析。共有 11 项研究符合纳入标准，由两名独立评审员进行的偏倚风险评估确定所有评估标准的偏倚风险较低。马里一线 AL 治疗组的 ACPRc 为 99.0% (95% CI (98.3%, 99.8%))，而非 AL 治疗组的 ACPRc 为 98.9% (95% CI (98.3%, 99.5%)) ）。非 AL 治疗组和 AL 治疗组之间的 ACPRc 差异不具有统计学意义 (p = .752)，这表明马里除了 AL 一线治疗之外还有潜在的治疗替代方案。 ACT 在马里治疗无并发症的恶性疟疾方面仍然非常有效。 需要持续对 ACT 进行针对具体国家的荟萃分析，以监测和评估药物疗效模式，以指导当地疟疾治疗政策，特别是在观察到东南亚青蒿素耐药性和卢旺达部分耐药性之后。