The Factors Resulted in Drug Resistance in Plamodium falciparum Infection Therapy-A Systematic Review and Meta-analysis

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• 英文论文题名：The Factors Resulted in Drug Resistance in Plamodium falciparum Infection Therapy-A Systematic Review and Meta-analysis
• 论文作者：Lijuan Zhou ; Hongjuan Peng
• 英文论文作者：Lijuan Zhou ; Hongjuan Peng ; Department of Pathogen Biology ; Guangdong Provincial Key Laboratory of Tropical Disease Research ; School of Public Health ; Southern Medical University
• 年：2016
• 作者机构：Department of Pathogen Biology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University;
• 英文论文关键词：falciparum malaria ; drug resistance ; drug categories ; ages ; gene mutation
• 会议召开时间：2016-08-08
• 会议录名称：中国动物学会寄生虫学专业委员会第十届全国寄生虫学青年工作者学术研讨会论文摘要集
• 英文会议录名称：The Abstracts of the Tenth Symposium for Yong Scientists of China Society of Parasitology
• 语种：英文
• 分类号：R531.3
• 学会代码：JISC
• 会议名称：中国动物学会寄生虫学专业委员会第十届全国寄生虫学青年工作者学术研讨会
• 会议地点：中国四川成都
• 主办单位：中国动物学会寄生虫学专业青年委员会
• 学会名称：中国动物学会寄生虫学专业委员会
• 页数：2
• 文件大小：345k
• 原文格式：D
• 会议级别：全国

摘要

Objectives: To generate pooled analyses to understand the impact of inadequate drugs in key subpopulations, and to provide information about the key drivers of drug resistance in Plasmodium falciparum(P. f) and promote awareness in the treatment of malaria, a systematic review and meta-Analysis based on published studies was conducted to examine the association between P. falciparum drug resistance and some related factors. Methods: Relevant original literatures were searched in multiple literature databases, including Pub Med, Trip Database, Current Controlled Trials, Clinical Trials, Web of Science, CNKI, CBM, Studies were selected based on strict screening with inclusion and exclusion criteria. Tests of heterogeneity, sensitivity and publication bias were performed with the Review Manager software, and meta-regression analyses were performed with the Stata software, Pooled risk ratios(RRs) with their 95%CIs were calculated and used to evaluate the risk of drug resistance resulted from different drugs, patients' ages or gene mutation. Results: 70 studies were included in the meta-analysis to compare the chances of drug resistance in the treatment of P. f infection. CQ therapy was more likely to produce drug resistance comparing to SP(RR=3.05, p<0.001) and MQ treatment had less chance to produce drug resistance comparing to SP(RR:0.26, p<0.001); No significant difference was found between AQ and SP(RR=1.18, p=0.58); ACTs can also resulted in drug resistance, no significant difference was found of drug resistance between AS+AQ and AS+SP(RR=0.69, p=0.11); AS+AQ and AL(RR=1.07, p=0.7); AS+MQ and AL(RR:0.71, p=0.21); However, AS+SP was more easily to produce drug resistance comparing to AL(RR=2.94, p <0.001); DHA+PQ had less chance to produce drug resistance comparing to AL(RR: 0.7, p<0.05), Non ACTs was easier to emerge drug resistance in treating P. f infection comparing to ACTs(RR=1.82, p <0.001). On the other hand, falciparum malaria treatment in the patients under 5 years old was more likely to produce drug resistance comparing to the other age groups(RR=1.49, p <0.05). pfcrt /pfmdr gene mutation was associated with quinolines drug resistance(RR=4.45, p <0.05), while dfhr/dhps gene mutation was associated with SP drug resistance(RR=5.37, p <0.05), The statistical heterogeneity was significant, no significant difference was observed in the sensitivity analysis, and there was no publication bias found in this meta-analysis. Conclusion: The meta-analysis found that P. f resistance was significantly associatedwith drug categories which was used in the treatment: CQ therapy was more likely to produce drug resistance when comparing to SP therapy; drug resistance emerged chance was lower in MQ therapy when comparing to SP therapy; non ACTs was more easily to produce drug resistance comparing to ACTs; more chances of drug resistance was identified in AS+SP combination comparing to AL combination; less chances of drug resistance was found in DHA+PQ combination comparing to AL combination; It was also identified that P. f drug resistance was more likely to emerge in the treatment for the patients under 5 years old comparing to the other age groups. Furthermore, Gene mutation in pfcrt/pfmdr gene, or in dhfr/dhps gene was significantly associated with P. f drug resistance to quinolines or SP, respectively.
Objectives: To generate pooled analyses to understand the impact of inadequate drugs in key subpopulations, and to provide information about the key drivers of drug resistance in Plasmodium falciparum(P. f) and promote awareness in the treatment of malaria, a systematic review and meta-Analysis based on published studies was conducted to examine the association between P. falciparum drug resistance and some related factors. Methods: Relevant original literatures were searched in multiple literature databases, including Pub Med, Trip Database, Current Controlled Trials, Clinical Trials, Web of Science, CNKI, CBM, Studies were selected based on strict screening with inclusion and exclusion criteria. Tests of heterogeneity, sensitivity and publication bias were performed with the Review Manager software, and meta-regression analyses were performed with the Stata software, Pooled risk ratios(RRs) with their 95%CIs were calculated and used to evaluate the risk of drug resistance resulted from different drugs, patients' ages or gene mutation. Results: 70 studies were included in the meta-analysis to compare the chances of drug resistance in the treatment of P. f infection. CQ therapy was more likely to produce drug resistance comparing to SP(RR=3.05, p<0.001) and MQ treatment had less chance to produce drug resistance comparing to SP(RR:0.26, p<0.001); No significant difference was found between AQ and SP(RR=1.18, p=0.58); ACTs can also resulted in drug resistance, no significant difference was found of drug resistance between AS+AQ and AS+SP(RR=0.69, p=0.11); AS+AQ and AL(RR=1.07, p=0.7); AS+MQ and AL(RR:0.71, p=0.21); However, AS+SP was more easily to produce drug resistance comparing to AL(RR=2.94, p <0.001); DHA+PQ had less chance to produce drug resistance comparing to AL(RR: 0.7, p<0.05), Non ACTs was easier to emerge drug resistance in treating P. f infection comparing to ACTs(RR=1.82, p <0.001). On the other hand, falciparum malaria treatment in the patients under 5 years old was more likely to produce drug resistance comparing to the other age groups(RR=1.49, p <0.05). pfcrt /pfmdr gene mutation was associated with quinolines drug resistance(RR=4.45, p <0.05), while dfhr/dhps gene mutation was associated with SP drug resistance(RR=5.37, p <0.05), The statistical heterogeneity was significant, no significant difference was observed in the sensitivity analysis, and there was no publication bias found in this meta-analysis. Conclusion: The meta-analysis found that P. f resistance was significantly associatedwith drug categories which was used in the treatment: CQ therapy was more likely to produce drug resistance when comparing to SP therapy; drug resistance emerged chance was lower in MQ therapy when comparing to SP therapy; non ACTs was more easily to produce drug resistance comparing to ACTs; more chances of drug resistance was identified in AS+SP combination comparing to AL combination; less chances of drug resistance was found in DHA+PQ combination comparing to AL combination; It was also identified that P. f drug resistance was more likely to emerge in the treatment for the patients under 5 years old comparing to the other age groups. Furthermore, Gene mutation in pfcrt/pfmdr gene, or in dhfr/dhps gene was significantly associated with P. f drug resistance to quinolines or SP, respectively.

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