A Cochrane review 1 (review [Abstract]) evaluating the six-dose regimen of artemether-lumefantrine for treating uncomplicated falciparum malaria included 9 trials with 4547 participants. Total failure at day 28 for artemether-lumefantrine was lower when compared with amodiaquine (270 participants, 1 trial), amodiaquine plus sulfadoxine-pyrimethamine (507 participants, 1 trial), but not with chloroquine plus sulfadoxine-pyrimethamine (201 participants, 2 trials). In comparisons with artemisinin derivative combinations, artemether-lumefantrine performed better than amodiaquine plus artesunate (668 participants, 2 trials), worse than mefloquine plus artesunate (270 participants, 4 trials), and no differently to dihydroartemisinin-napthoquine-trimethoprim (89 participants, 1 trial).
Another Cochrane review 2 (review [Abstract]), evaluating the four-dose regimen of artemether-lumefantrine for treating uncomplicated falciparum malaria, included 7 trials involving a total of 2057 participants. Total failure by day 28 (day 42 for sulfadoxine-pyrimethamine and day 63 for mefloquine) was the primary outcome. More people tended to fail treatment with artemether-lumefantrine than with other drugs, including sulfadoxine-pyrimethamine (1 trial, 247 children), halofantrine (1 trial, n=86 teens and adults), and mefloquine (1 high quality trial, n=233 teens and adults; difference statistically significant for mefloquine). When compared with chloroquine, artemether-lumefantrine was better (2 trials, n=378, children and adults), but over 50% of the participants treated with chloroquine had total failure by day 28. Fewer people failed treatment with the six-dose regimen compared to the four-dose regimen (RR 7.71, 95% CI 2.99 to 19.88; 1 trial, n=306 children and adults).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment, inadequate intention-to-treat adherence).
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