Revealing the artemisinin and piperaquine treatment failure: a systematic review

Background: Artemisinin-based combination therapy (ACT) consists of a potent artemisinin component. Since the dihydroartemisinin performance effectiveness depends on piperaquine interaction still challenging, further research needs to establish the current status of artemisinin resistance relative to its geography and recognize any drug resistance interaction between dihydroartemisinin and piperaquine. Aim: This systematic review was aimed to find out the effect of dihydroartemisinin and piperaquine interaction concerning resistance, recurrence, parasitological failure, clinical failure, parasite clearance time, parasite reduction ratio, cure rate, which may affect treatment failure of patients with uncomplicated P. falciparum. Method: The article was not limited to year and country. This study analyzed any effect of interaction. Pubmed and Scopus were used as electronic databases, and MeSH terms and keywords were used to find specific studies. A total of 2131 studies were initially identified; however, 20 were eligible for qualitative synthesis. Result: The dihydroartemisinin piperaquine cure rate reported in Asia and Africa was above 98%. Eight RCTs, eleven prospective cohort studies, and one retrospective and prospective cohort study were included in this review. Design studies did not compare the same anti-malarial drug pattern, so it was difficult to do a pooled analysis. Even though this drug combination did not show a clear description of piperaquine resistance can affect artemisinin resistance, the adequate clinical and parasitological failure (ACPR) from this research reached above 93%, and for early treatment failure (ETF), late clinical failure (LCF), and late parasitological failure (LPF), were almost 0 %. Conclusion: The dihydroartemisinin-piperaquine combination still has highly efficacious therapy to fight malaria in some areas based on these multiple factors and reviews.