Intralesional treatment with meglumine antimoniate in three patients with New World cutaneous leishmaniasis and large periarticular lesions with comorbidities

Pimentel, Maria Inês Fernandes; Vasconcellos, Érica de Camargo Ferreira e; Ribeiro, Carla de Oliveira; Lyra, Marcelo Rosandiski; Saheki, Maurício Naoto; Salgueiro, Mariza de Matos; Antônio, Liliane de Fátima; Schubach, Armando de Oliveira

doi:10.1590/0037-8682-0323-2016

Cited by 8 publications

(13 citation statements)

References 7 publications

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“…One interesting result of our study was that 7 patients treated with IL-MA had lesions larger than 3 cm, and no differences in cure rates or AEs was found compared to the subgroup with lesions smaller than 3 cm. Other authors reported a good response and safety with this local treatment in patients with lesions larger than 3 cm ( Oliveira-Neto et al, 1997 ; Vasconcellos et al, 2012 ; Pimentel et al, 2017 ; Duque et al, 2019 ). This fact may indicate that the size restriction in the ACL guidelines ( Brasil, 2017 ; PAHO/WHO, 2019 ) may be revised in the future due to a lack of scientific evidence to support this restriction.…”

Section: Discussionmentioning

confidence: 85%

A retrospective cohort study of the effectiveness and adverse events of intralesional pentavalent antimonials in the treatment of cutaneous leishmaniasis

Rodrigues

Ferreira

Barroso

et al. 2020

International Journal for Parasitology: Drugs and Drug Resistan

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Section: Discussionmentioning

confidence: 85%

A retrospective cohort study of the effectiveness and adverse events of intralesional pentavalent antimonials in the treatment of cutaneous leishmaniasis

Rodrigues

Ferreira

Barroso

et al. 2020

International Journal for Parasitology: Drugs and Drug Resistan

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“…It is known that the use of systemic meglumine antimoniate can be lead to serious adverse effects, so the application in the lesion site showed to be an efficacious and more secure alternative to treat CL. Some authors have demonstrated that the intralesional MA is as effective as the systemic MA and had few adverse effects [43–45]. It is important to note that, unlike in the articles included in this study, Vasconcellos et al (2014) [46] reported that one patient presented eczema after the treatment with intralesional meglumine antimoniate.…”

Section: Discussionmentioning

confidence: 89%

Pentavalent Antimonials Combined with Other Therapeutic Alternatives for the Treatment of Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review

Berbert

Mello

Nassif

et al. 2018

Dermatology Research and Practice

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The first choice drugs for the treatment of cutaneous and mucocutaneous leishmaniasis are pentavalent antimonials, sodium stibogluconate, or meglumine antimoniate. However, the treatment with these drugs is expensive, can cause serious adverse effects, and is not always effective. The combination of two drugs by different routes or the combination of an alternative therapy with systemic therapy can increase the efficacy and decrease the collateral effects caused by the reference drugs. In this systematic review we investigated publications that described a combination of nonconventional treatment for cutaneous and mucocutaneous with pentavalent antimonials. A literature review was performed in the databases Web of Knowledge and PubMed in the period from 01st of December 2004 to 01st of June 2017, according to Prisma statement. Only clinical trials involving the treatment for cutaneous or mucocutaneous leishmaniasis, in English, and with available abstract were added. Other types of publications, such as reviews, case reports, comments to the editor, letters, interviews, guidelines, and errata, were excluded. Sixteen articles were selected and the pentavalent antimonials were administered in combination with pentoxifylline, granulocyte macrophage colony-stimulating factor, imiquimod, intralesional sodium stibogluconate, ketoconazole, silver-containing polyester dressing, lyophilized LEISH-F1 protein, cryotherapy, topical honey, and omeprazole. In general, the combined therapy resulted in high rates of clinical cure and when relapse or recurrence was reported, it was higher in the groups treated with pentavalent antimonials alone. The majority of the articles included in this review showed that cure rate ranged from 70 to 100% in patients treated with the combinations. Serious adverse effects were not observed in patients treated with drugs combination. The combination of other drugs or treatment modalities with pentavalent antimonials has proved to be effective for cutaneous and mucocutaneous leishmaniasis and for most seemed to be safe. However, new randomized, controlled, and multicentric clinical trials with more robust samples should be performed, especially the combination with immunomodulators.

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“…We emphasize the efficiency of MA infiltrations in lesions with areas greater than 900mm 2 and in those situated in topography where greater expertise from the medical personnel is required (including head and periarticular areas). The mastery of the infiltration technique and a good knowledge of local anatomy turn it safe for the treatment of any corporal segment [ 6 , 13 ]. Even though there were no differences between the treatment groups and the topography (cephalic segment and periarticular regions) of the cutaneous lesion, as found in several studies [ 13 , 21 , 22 , 24 , 27 , 36 ], it is recommended to perform controlled prospective studies.…”

Section: Discussionmentioning

confidence: 99%

“…The mastery of the infiltration technique and a good knowledge of local anatomy turn it safe for the treatment of any corporal segment [ 6 , 13 ]. Even though there were no differences between the treatment groups and the topography (cephalic segment and periarticular regions) of the cutaneous lesion, as found in several studies [ 13 , 21 , 22 , 24 , 27 , 36 ], it is recommended to perform controlled prospective studies.…”

Section: Discussionmentioning

confidence: 99%

“…Leishmaniasis Clinical Research and Surveillance Laboratory at Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (INI / Fiocruz) is a reference center for the treatment of American tegumentary leishmaniasis (ATL) in the state of Rio de Janeiro, with experienced professionals in the diagnosis and the management of the disease. For more than three decades, AR and IL MA have been used at this center when intravenous or intramuscular treatments are formally contraindicated [ 9 , 10 , 11 , 12 , 13 ]. Intramuscular treatment with AR has been widely used in the referral center with good effectiveness in patients from all over the country [ 14 ], and lower toxicity when compared to SR.…”

Section: Introductionmentioning

confidence: 99%

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An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil

et al. 2021

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Background Treatment of cutaneous leishmaniasis (CL) remains challenging since the drugs currently used are quite toxic, thus contributing to lethality unrelated to the disease itself but to adverse events (AE). The main objective was to evaluate different treatment regimens with meglumine antimoniate (MA), in a reference center in Rio de Janeiro, Brazil. Methodology A historical cohort of 592 patients that underwent physical and laboratory examination were enrolled between 2000 and 2017. The outcome measures of effectiveness were epithelialization and complete healing of cutaneous lesions. AE were graded using a standardized scale. Three groups were evaluated: Standard regimen (SR): intramuscular (IM) MA 10–20 mg Sb5+/kg/day during 20 days (n = 46); Alternative regimen (AR): IM MA 5 mg Sb5+/kg/day during 30 days (n = 456); Intralesional route (IL): MA infiltration in the lesion(s) through subcutaneous injections (n = 90). Statistical analysis was performed through Fisher exact and Pearson Chi-square tests, Kruskal-Wallis, Kaplan-Meier and log-rank tests. Results SR, AR and IL showed efficacy of 95.3%, 84.3% and 75.9%, with abandonment rate of 6.5%, 2.4% and 3.4%, respectively. IL patients had more comorbidities (58.9%; p = 0.001), were mostly over 50 years of age (55.6%), and had an evolution time longer than 2 months (65.6%; p = 0.02). Time for epithelialization and complete healing were similar in IL and IM MA groups (p = 0.9 and p = 0.5; respectively). Total AE and moderate to severe AE that frequently led to treatment interruption were more common in SR group, while AR and IL showed less toxicity. Conclusions/Significance AR and IL showed less toxicity and may be good options especially in CL cases with comorbidities, although SR treatment was more effective. IL treatment was an effective and safe strategy, and it may be used as first therapy option as well as a rescue scheme in patients initially treated with other drugs.

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Intralesional treatment with meglumine antimoniate in three patients with New World cutaneous leishmaniasis and large periarticular lesions with comorbidities

Cited by 8 publications

References 7 publications

A retrospective cohort study of the effectiveness and adverse events of intralesional pentavalent antimonials in the treatment of cutaneous leishmaniasis

A retrospective cohort study of the effectiveness and adverse events of intralesional pentavalent antimonials in the treatment of cutaneous leishmaniasis

Pentavalent Antimonials Combined with Other Therapeutic Alternatives for the Treatment of Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review

An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil

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