Comparative effect of dihydroartemisinin-piperaquine and artemether-lumefantrine on gametocyte clearance and haemoglobin recovery in children with uncomplicated Plasmodium falciparum malaria in Africa: a systematic review and meta-analysis of randomized control trials

Background: Plasmodium falciparum gametocytaemia has been associated with anaemia. The aim of this review was to synthesize available evidence on the comparative effect of dihydroartemisinin-piperaquine (DHA-PQ) and artemether-lumefantrine (AL) on gametocyte clearance and haemoglobin recovery in chil-dren with uncomplicated P. falciparum malaria in Africa. Methods: A systematic literature search was undertaken to identify relevant articles from online databases. The search was performed from August 2020 to 30 April 2021. Extracted data from eligible studies were pooled as risk ratios with 95% confidence intervals (CI). Results: Gametocyte carriage was reduced in both treatment groups, with no significant difference found between the groups. However, on days 28 and 42, a significant increase in serum haemoglobin level from baseline was observed in the DHA-PQ group (standardized mean difference 0.15, 95% CI 0.05-0.26; participants = 2715; studies = 4; I 2 = 32%, high quality of evidence) compared with the AL group (mean dif-ference 0.35, 95% CI 0.12-0.59; participants = 1434; studies = 3; I 2 = 35%, high quality of evidence). Conclusion: DHA-PQ had a greater impact on haemoglobin recovery than AL on days 28 and 42; this difference was significant. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

Both DHA-PQ and AL were effective in reducing gametocyte carriage, but DHA-PQ showed a significant increase in serum haemoglobin levels compared to AL on days 28 and 42, indicating a greater impact on haemoglobin recovery.