Safety and effectiveness of antimalarial therapy in sickle cell disease: a systematic review and network meta-analysis.
Augustina Frimpong,Augustina Frimpong,Laty G. Thiam,Benjamin Arko-Boham,Ewurama D. A. Owusu,Ewurama D. A. Owusu,George O. Adjei +6 more
TL;DR: Overall, the meta-analysis showed that antimalarial chemoprophylaxis provided protection against parasitemia and clinical malaria episodes in children with SCD.
read more
Abstract: About 80% of all reported sickle cell disease (SCD) cases in children anually are recorded in Africa. Although malaria is considered a major cause of death in SCD children, there is limited data on the safety and effectiveness of the available antimalarial drugs used for prophylaxis. Also, previous systematic reviews have not provided quantitative measures of preventive effectiveness. The purpose of this research was to conduct a systematic review and meta-analysis of the available literature to determine the safety and effectiveness of antimalarial chemoprophylaxis used in SCD patients. We searched in PubMed, Medline, CINAHL, POPLine and Cochrane library, for the period spanning January 1990 to April 2018. We considered randomized or quasi-randomized controlled trials comparing any antimalarial chemoprophylaxis to, 1) other antimalarial chemoprophylaxis, 2) placebo or 3) no intervention, in SCD patients. Studies comparing at least two treatment arms, for a minimum duration of three months, with no restriction on the number of patients per arm were reviewed. The data were extracted and expressed as odds ratios. Direct pairwise comparisons were performed using fixed effect models and the heterogeneity assessed using the I-square. Six qualified studies that highlighted the importance of antimalarial chemoprophylaxis in SCD children were identified. In total, seven different interventions (Chloroquine, Mefloquine, Mefloquine artesunate, Proguanil, Pyrimethamine, Sulfadoxine-pyrimethamine, Sulfadoxine-pyrimethamine amodiaquine) were evaluated in 912 children with SCD. Overall, the meta-analysis showed that antimalarial chemoprophylaxis provided protection against parasitemia and clinical malaria episodes in children with SCD. Nevertheless, the risk of hospitalization (OR = 0.72, 95% CI = 0.267–1.959; I2 = 0.0%), blood transfusion (OR = 0.83, 95% CI = 0.542–1.280; I2 = 29.733%), vaso-occlusive crisis (OR = 19, 95% CI = 1.713–2.792; I2 = 93.637%), and mortality (OR = 0.511, 95% CI = 0.189–1.384; I2 = 0.0%) did not differ between the intervention and placebo groups. The data shows that antimalarial prophylaxis reduces the incidence of clinical malaria in children with SCD. However, there was no difference between the occurrence of adverse events in children who received placebo and those who received prophylaxis. This creates an urgent need to assess the efficacy of new antimalarial drug regimens as potential prophylactic agents in SCD patients. PROSPERO (CRD42016052514).
read more
Chat with Paper
AI Agents for this Paper
Find similar papers on Google Scholar, PubMed and Arxiv
Write a critical review of this paper
Analyze citations of this paper to find unaddressed research gaps
Citations
Treatment and prevention of malaria in children
TL;DR: The RTS,S/AS01 vaccine gives partial protection against falciparum malaria and is being evaluated in large, pilot studies in Ghana, Malawi, and Kenya as a complementary tool to other preventive measures.
60
Caring for Africa's sickle cell children: will we rise to the challenge?
Assaf P. Oron,Dennis L. Chao,Echezona E. Ezeanolue,Loveth N. Ezenwa,Frédéric B. Piel,Osifo Telison Ojogun,Sophie Uyoga,Thomas N. Williams,Obiageli E Nnodu +8 more
TL;DR: A globally funded effort starting with these countries and expanding elsewhere in Africa and to other high-burden countries, including India, could transform the lives of SCD children worldwide and help countries to attain their Sustainable Development Goals.
Sickle cell disease in sub-Saharan Africa: transferable strategies for prevention and care.
TL;DR: In this paper, the authors describe the epidemiology, pathophysiology, clinicobiological profile, and psychosocial effects of sickle cell disease in sub-Saharan Africa and highlight transferable strategies already used for the successful management of the condition and key strategies and recommendations for affordable and comprehensive care.
38
Combining malaria vaccination with chemoprevention: a promising new approach to malaria control
Brian Greenwood,Matthew Cairns,Mike Chaponda,R Matthew Chico,Alassane Dicko,Jean-Bosco Ouédraogo,Kamija S. Phiri,Feiko O. ter Kuile,Daniel Chandramohan +8 more
TL;DR: The combination of a pre-erythrocytic stage malaria vaccine with an effective chemopreventive regimen could make a valuable contribution to malaria control and elimination in a variety of clinical or epidemiological situations as discussed by the authors.
Sickle cell disease and malaria: decreased exposure and asplenia can modulate the risk from Plasmodium falciparum.
Richard Mwaiswelo,Richard Mwaiswelo,William Mawala,Per Ole Iversen,Per Ole Iversen,Mariane de Montalembert,Lucio Luzzatto,Julie Makani +7 more
TL;DR: A 17 year-old Tanzanian male with known SCD admitted to Muhimbili National Hospital, a tertiary referral centre in Dar-es-Salaam, following an attack of malaria is a compelling reminder that long-term anti-malarial prophylaxis should be offered to all patients with SCD who live in malaria-endemic areas.
References
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
Julian P T Higgins,Douglas G. Altman test,Peter C Gøtzsche,Peter Jüni,David Moher,Andrew D Oxman,Jelena Savović,Kenneth F. Schulz,Laura Weeks,Jonathan A C Sterne +9 more
TL;DR: The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate.
30.5K
The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants
TL;DR: This meta-analysis of RCT and observational studies found that the use of probiotics was beneficial for the prevention of severe NEC, late-onset sepsis, and all-cause mortality in VLBW infants.
Pyrimethamine and Proguanil Resistance-Conferring Mutations in Plasmodium falciparum Dihydrofolate Reductase: Polymerase Chain Reaction Methods for Surveillance in Africa
TL;DR: Methods for collecting fingerstick blood onto filter paper strips that are air-dried, then stored and transported at room temperature and a nested PCR technique that has improved sensitivity and specificity are reported.
694
Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies
Deepa Manwani,Paul S. Frenette +1 more
TL;DR: The role of various cellular and soluble participants in the vaso-occlusive cascade and the opportunities for therapeutic intervention are summarized in this review.
407
P. falciparum dihydrofolate reductase and dihydropteroate synthase mutations: epidemiology and role in clinical resistance to antifolates.
TL;DR: Molecular epidemiological surveys, studies of in vivo selection of mutant alleles by drug treatment, and prospective studies of the ability of mutation-specific assays to predict clinical outcomes are summarized and the potential use of these assays for surveillance of resistance is discussed.
166