title: The Relative Effects of Artemether-lumefantrine and Non-artemisinin Antimalarials on Gametocyte Carriage and Transmission of Plasmodium falciparum: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Artemisinin-based combination therapies (ACTs) have been widely adopted as first-line agents to treat uncomplicated falciparum malaria due to their activity against multidrug resistant parasites. ACTs may also disrupt transmission through a direct antigametocyte effect, but the extent of this effect is uncertain. We assessed the evidence for and estimated the effects of the most widely-deployed ACT, artemether-lumefantrine (AL), relative to non-ACTs on gametocyte clearance and transmission interruption.
  
  
  METHODS
  We searched electronic databases for randomized controlled trials comparing AL to non-ACTs that reported gametocyte counts or results of mosquito-feeding assays. Two authors working independently assessed eligibility, extracted data, and evaluated the risk of bias. We conducted meta-analyses using a random-effects model.
  
  
  RESULTS
  We identified 22 eligible trials. The pooled odds of gametocytemia at 1 week were lower in AL- compared to non-ACT-treated participants (odds ratio [OR] 0.09; 95% confidence interval [CI], 0.06-0.15; I2 = 0.60, P < .01; 15 trials). The odds of transmission to mosquitoes were also lower in AL treatment groups (OR 0.06; 95% CI, 0.00-0.47, P < .01 at 7 days post-treatment; 1 trial; OR 0.56; 95% CI, 0.36-0.88, P = .01 at 14 days post-treatment; 1 trial).
  
  
  CONCLUSIONS
  AL is superior to non-ACTs in reducing gametocytemia, and, based on limited evidence, abating transmission to mosquitoes. The transmission-limiting benefit of AL has relevance for policymakers planning optimal utilization of control strategies, including use of ACTs for malaria treatment and chemoprevention.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine.|Graduate Training Program in Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Ippolito
authors.affiliation: Graduate Training Program in Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health.|Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Julia
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine.|Graduate Training Program in Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mullin
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine.|Graduate Training Program in Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mallow
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine.|Graduate Training Program in Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Nadia
authors.initials: N
authors.lastname: Morgan
authors.affiliation: Department of Medicine, University of California San Francisco.
authors.forename: Erika
authors.initials: E
authors.lastname: Wallender
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Tianjing
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Medicine, University of California San Francisco.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenthal
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use; D000077549:Artemether; D037621:Artemisinins / Q000494:pharmacology* / Q000627:therapeutic use; D009033:Culicidae / Q000469:parasitology*; D004983:Ethanolamines / Q000494:pharmacology* / Q000627:therapeutic use; D005449:Fluorenes / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000469:parasitology; D010963:Plasmodium falciparum / Q000187:drug effects*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077549:Artemether; D000078102:Lumefantrine
keywords: artemether-lumefantrine; artemisinin-based combination therapy; gametocytes; malaria; meta-analysis