# name
Gametocyte carriage in uncomplicated Plasmodium falciparum
                malaria following treatment with artemisinin combination
                therapy: a systematic review and meta-analysis of individual
                patient data

# metadata.dc.description.abstract[].value
BACKGROUND: Gametocytes are responsible for transmission of
                malaria from human to mosquito. Artemisinin combination therapy
                (ACT) reduces post-treatment gametocyte carriage, dependent upon
                host, parasite and pharmacodynamic factors. The gametocytocidal
                properties of antimalarial drugs are important for malaria
                elimination efforts. An individual patient clinical data
                meta-analysis was undertaken to identify the determinants of
                gametocyte carriage and the comparative effects of four ACTs:
                artemether-lumefantrine (AL), artesunate/amodiaquine (AS-AQ),
                artesunate/mefloquine (AS-MQ), and
                dihydroartemisinin-piperaquine (DP). METHODS: Factors associated
                with gametocytaemia prior to, and following, ACT treatment were
                identified in multivariable logistic or Cox regression analysis
                with random effects. All relevant studies were identified
                through a systematic review of PubMed. Risk of bias was
                evaluated based on study design, methodology, and missing data.
                RESULTS: The systematic review identified 169 published and 9
                unpublished studies, 126 of which were shared with the WorldWide
                Antimalarial Resistance Network (WWARN) and 121 trials including
                48,840 patients were included in the analysis. Prevalence of
                gametocytaemia by microscopy at enrolment was 12.1 %
                (5887/48,589), and increased with decreasing age, decreasing
                asexual parasite density and decreasing haemoglobin
                concentration, and was higher in patients without fever at
                presentation. After ACT treatment, gametocytaemia appeared in
                1.9 % (95 % CI, 1.7-2.1) of patients. The appearance of
                gametocytaemia was lowest after AS-MQ and AL and significantly
                higher after DP (adjusted hazard ratio (AHR), 2.03; 95 % CI,
                1.24-3.12; P = 0.005 compared to AL) and AS-AQ fixed dose
                combination (FDC) (AHR, 4.01; 95 % CI, 2.40-6.72; P < 0.001
                compared to AL). Among individuals who had gametocytaemia before
                treatment, gametocytaemia clearance was significantly faster
                with AS-MQ (AHR, 1.26; 95 % CI, 1.00-1.60; P = 0.054) and slower
                with DP (AHR, 0.74; 95 % CI, 0.63-0.88; P = 0.001) compared to
                AL. Both recrudescent (adjusted odds ratio (AOR), 9.05; 95 % CI,
                3.74-21.90; P < 0.001) and new (AOR, 3.03; 95 % CI,
                1.66-5.54; P < 0.001) infections with asexual-stage parasites
                were strongly associated with development of gametocytaemia
                after day 7. CONCLUSIONS: AS-MQ and AL are more effective than
                DP and AS-AQ FDC in preventing gametocytaemia shortly after
                treatment, suggesting that the non-artemisinin partner drug or
                the timing of artemisinin dosing are important determinants of
                post-treatment gametocyte dynamics.

# metadata.dc.rights[].value
cc by (c) WWARN Gametocyte Study Group, 2016

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Gametocyte carriage in uncomplicated Plasmodium falciparum
                malaria following treatment with artemisinin combination
                therapy: a systematic review and meta-analysis of individual
                patient data