The Effect of Artemisinin-Based Drugs vs Non-artemisinin-based Drugs on Gametophyte Carrying in the Body After the Treatment of Uncomplicated Falciparum Malaria: A Systematic Review and Meta-analysis.

Shiyuan Guo,Qi Wang,Xinan Huang,Zhiyong Xu,Yueming Yuan,Wenfeng Guo,Qin Xu,Hongying Zhang,Changqing Li,Jianping Song,Wanting Wu,Nadia Julie,Yuanyuan Zou,Yexiao Tang,Zhibin Wu,Changsheng Deng

doi:10.3389/fphar.2021.707498

Abstract

The WHO recommends Artemisinin-based combination therapy (ACTs) as the first-line treatment for malaria. This meta-analysis aims to analyze the effects of artemisinin and its derivatives as well as non-artemisinin drugs on the gametophytes in the host during the treatment of falciparum malaria. Fourteen studies were included in this analysis, and the artemisinin combination drugs involved were: artemether-lumefantrine (AL), artemisinin (AST), artemether-benflumetol (AB), dihydroartemisinin-piperaquine + trimethoprim + primaquine (CV8), amodiaquine + sulfadoxine-pyrimethamine (ASP), pyronaridine-phosphate + dihydroartemisinin (PP-DHA), dihydroartemisinin (DHA), and mefloquine + artesunate (MA), with 1702 patients. The control intervention measures involved the following: sulfadoxine-pyrimethamine (SP), mefloquine (MQ), atovaquone-proguanil (AT-PG), chloroquine + sulfadoxine-pyrimethamine (C-SP), quinine (Q), pyronaridine-phosphate (PP), pyronaridine (PN), and mefloquine + primaquine (MP), with 833 patients. The effect of ACTs was more obvious (OR = 0.37, 95%CI: 0.22–0.62, p < 0.05). In the control group of second malaria attacks, the difference between the two groups was not statistically significant (RD = 1.16, 95%CI: 0.81–1.66, p < 0.05); there was no significant difference in treatment failure during follow-up (RD = -0.01, 95%CI: 0.04–0.03, p < 0.05). There were also very few serious adverse events in both groups. ACTs showed good therapeutic effects in preventing gametocythemia but did not control the recrudescence rate and overall cure, which indicated the effectiveness of the combination of antimalarial drugs. Further research is required to explore which compatibility method is most conducive to the development of clinical malaria control.

Highlights

Malaria is one of the most important public health problems in the world
We report the results related to the use of ACTs and nACTs for the treatment of uncomplicated falciparum malaria
Sensitivity analysis was conducted on 11 studies that reported the rate of gametophyte carrying conditions after 7 days of treatment, and the results showed that good stability of the analysis results (OR: 0.2581, 95%confidence interval (CI): 0.1784–0.3736, p < 0.001) (Figures 5.1–B)

Summary

Introduction

Malaria is one of the most important public health problems in the world. It has long threatened people’s health and life safety and affected social and economic development. Malaria is a important human parasitic disease and a common cause of fever in tropical areas (Mehari et al, 2021). The spread of malaria depends on the presence of gametophytes in peripheral blood (Johnston et al, 2014). After the Anopheles mosquito sucks blood, the mature gametophytes continue to complete the life cycle of malaria in the mosquitoes. The mechanism of formation of gametophytes is unclear and is hypothesized to be related to the density of infected asexual parasites, anemia, the duration of malaria symptoms, and the strength of immunity. The elimination of malaria on a global scale is still facing huge challenges

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