Efficacy and Safety of Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium Falciparum Malaria in West Africa : A Systematic Review and MetaAnalysis

Abstract

Background : Artemether-lumefantrine (AL) constitutes the artemisinin-based combination therapy (ACT) of first choice of the treatement of uncomplicated Plasmodium falciparum malaria.The study aim to estimate the pooled Adequate Clinical and Parasitological Response (ACPR) rate at day 28 following AL treatment in West Africa, and to characterise systematically the safety and tolerability profile of AL across all included studies. Methods : Systematic review and meta-analysis following PRISMA 2020 guidelines. Databases searched: PubMed/MEDLINE, Cochrane Library, WHO AFRO repository, ClinicalTrials.gov (last updated May 2026). Eligible study designs included prospective cohort studies, single-arm efficacy studies, and randomised controlled trials with an extractable AL arm. Day-28 PCR-corrected ACPR was pooled as logit-transformed proportions under a DerSimonian-Laird random-effects model. Results : Ten studies from seven countries, and 2,600 participants were included. The pooled ACPR was 98.7% (95% CI : 97.5–99.3%), with substantial between-study heterogeneity (I² = 60%; Tau² = 0.56) and a 95% prediction interval of 91.6–99.8%. One real-world effectiveness study of unsupervised treatment (Nanoro, Burkina Faso) reported a markedly lower ACPR of 77.8%; including it widened heterogeneity (I² = 94%) and the prediction interval (41.8–100%), reflecting the different construct measured. Adverse events were predominantly mild and transient ; no serious adverse event attributed to AL was reported across studies. Conclusion : Continuous, protocol-standardised therapeutic efficacy monitoring — particularly in high-transmission settings such as Niger — and attention to treatment adherence are recommended.