Arterolane-Piperaquine for the Treatment of Falciparum Malaria: A Meta-analysis of Randomized Controlled Trials

Full text

Mondal A1, Basu A2, Modak DC1, Goswami RP1
1. School of Tropical Medicine, Kolkata
2. Instute of Post Graduate Medical Educaon and Research
Arterolane-Piperaquine for the Treatment of Falciparum Malaria:
A Meta-analysis of Randomized Controlled Trials
Background
Artemisinin combinaon
therapy (ACT) resistance in
falciparum malaria has
emerged and is spreading.
Newer anmalarials are
needed to treat falciparum
malaria cases. Arterolane
maleate is a fully synthec
trioxolane anmalarial and
acve against Plasmodium
falciparum malaria.
Methods
We conducted a meta-
analysis to determine the
safety and ecacy of
arterolane maleate and
piperaquine combinaon
therapy for the treatment of
uncomplicated falciparum
malaria. We searched
PubMed/MEDLINE,
Cochrane Library, Google
Scholar, ClinicalTrials.gov and
MedRxiv using the search
term “arterolane AND
piperaquine AND
falciparum”. Three authors
conducted the search and
screened the results by tle,
abstract and full text. Data
extracon was done and
analysis was performed
using R version 4.2.0. Risk of
bias analysis was done using
Cochrane Risk of Bias tool
version 2. The non-inferiority
margin was set at 7%.
Results
Four studies1,2,3,4 were
included in the meta-
analysis. Three studies had
low risk of bias while one
had high risk of bias. Using
the xed eect model, the
28 days Polymerase Chain
Reacon (PCR) corrected risk
dierence between the
artemether-lumefantrine
and arterolane-piperaquine
was 0 (95% condence
interval -0.02 to 0.02)
whereas PCR uncorrected
risk dierence was 0.05 (95%
condence interval 0.02 to
0.07). On 42 days follow-up
the PCR uncorrected risk
dierence was 0.09 (95%
condence interval 0.06 to
0.12) while the PCR
corrected risk dierence was
0 (95% condence interval -
0.02 to 0.03). Adverse eect
prole was similar with risk
dierence of at least one
adverse eect being -0.01
(95% condence interval -
0.04 to 0.00).
Conclusion
Arterolane-piperaquine was
non-inferior to artemether-
lumefantrine for the
treatment of uncomplicated
falciparum malaria.
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falciparum malaria in Kenyan children: a single-centre, open-label, randomised, non-inferiority trial. Lancet Infect Dis. 2021 Jun 7;
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28 day PCR Corrected Risk Dierence
42 day PCR Uncorrected Risk Dierence
42 day PCR Corrected Risk Dierence
Study Risk of Bias
Hamaluba et al 2021 Low
Toure et al 2017 Low
Toure et al 2016 Low
Valecha et al 2012 High
Funnel Plot
28 day PCR Uncorrected Risk Dierence