Low dose glucantime therapy in Leishmania viannia braziliensis (Lvb) infections

Costa, Jackson Maurício Lopes; Marsden, Philip D.

doi:10.1590/s0037-86821988000200013

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…Embora haja relato anterior com doentes apresentando a forma cutânea da doença que responderam a doses menores que as habitualmente recomendadas de antimoniais 3 , a nossa paciente possuía lesão concomitante de mucosa, sabidamente de difícil tratamento. Neste caso, ressaltamos dois aspectos, primeiro a dificuldade no tratamento da LCM diante de pacientes cardiopatas e nefropatas, devido à falta de opções terapêuticas, com baixa toxicidade, bem como a falta de drogas com baixa toxicidade, e segundo a falta de resposta de resposta terapêutica ao alopurinol.…”

Section: Discussionunclassified

Um caso de leishmaniose cutâneo-mucosa tratado com sucesso com baixa dose de antimonial pentavalente

Amato

Oliveira

Silva

et al. 1998

Rev. Soc. Bras. Med. Trop.

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The authors report a case of a 89 years-old woman with mucocutaneous leishmaniasis and previous diabetes mellitus and high blood pressure, who had been treated with allopurinol for 10 months without healing of lesions. Afterwards, she has been treated with meglumine antimonate, "glucantime" for 4 days, with a total dose 2,380 mg of Sbv, but developed cardiac side effects and hypokalemia, hence the treatment was withdrawn. However, this patient developed total clinical regression of lesions, in spite of she has been received low dose of this drug.

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Section: Discussionunclassified

Um caso de leishmaniose cutâneo-mucosa tratado com sucesso com baixa dose de antimonial pentavalente

Amato

Oliveira

Silva

et al. 1998

Rev. Soc. Bras. Med. Trop.

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Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

et al. 2017

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BackgroundAlthough high dose of antimony is the mainstay for treatment of American cutaneous leishmaniasis (ACL), ongoing major concerns remain over its toxicity. Whether or not low dose antimony regimens provide non-inferior effectiveness and lower toxicity has long been a question of dispute.MethodsA single-blind, non-inferiority, randomized controlled trial was conducted comparing high dose with low dose of antimony in subjects with ACL treated at a referral center in Rio de Janeiro, an endemic area of Leishmania (Viannia) braziliensis transmission. The primary outcome was clinical cure at 360 days of follow-up in the modified-intention-to-treat (mITT) and per-protocol (PP) populations. Non-inferiority margin was 15%. Secondary objectives included occurrence of epithelialization, adverse events and drug discontinuations. This study was registered in ClinicalTrials.gov: NCT01301924.ResultsOverall, 72 patients were randomly assigned to one of the two treatment arms during October 2008 to July 2014. In mITT, clinical cure was observed in 77.8% of subjects in the low dose antimony group and 94.4% in the high dose antimony group after one series of treatment (risk difference 16.7%; 90% CI, 3.7–29.7). The results were confirmed in PP analysis, with 77.8% of subjects with clinical cure in the low dose antimony group and 97.1% in the high dose antimony group (risk difference 19.4%; 90% CI, 7.1–31.7). The upper limit of the confidence interval exceeded the 15% threshold and was also above zero supporting the hypothesis that low dose is inferior to high dose of antimony after one series of treatment. Nevertheless, more major adverse events, a greater number of adverse events and major adverse events per subject, and more drug discontinuations were observed in the high dose antimony group (all p<0.05). Interestingly, of all the subjects who were originally allocated to the low dose antimony group and were followed up after clinical failure, 85.7% achieved cure after a further treatment with local therapy or low dose of antimony.ConclusionsCompared with high dose, low dose of antimony was inferior at the pre-specified margin after one series of treatment of ACL, but was associated with a significantly lower toxicity. While high dose of antimony should remain the standard treatment for ACL, low dose antimony treatment might be preferred when toxicity is a primary concern.

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Glucantime resistant Leishmania promastigotes are sensitive to pentostam

Moreira¹,

Guerra²,

Petrillo-Peixoto³

1992

Rev. Soc. Bras. Med. Trop.

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Growth inhibition in vitro tests were used to study the susceptibility to pentostam o f different Leishmania strains involved in cutaneous and mucocutaneos leishmaniasis -one glucantime sensitive strain, three naturally glucantime resistant strains and one glucantime resistant line developed by in vitro drug exposure. Contrasting with the high degree , o f glucantime resistance, all strains were sensitive to pentostam. These differences suggest that there is some relationship between chemical structure and in vitro activity fo r these antimonial compounds. These data justify a clinical re-evaluation to compare therapeutic efficacy o f glucantime and pentostam in the treatment o f leishmaniasis.

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Low dose glucantime therapy in Leishmania viannia braziliensis (Lvb) infections

Cited by 3 publications

References 7 publications

Um caso de leishmaniose cutâneo-mucosa tratado com sucesso com baixa dose de antimonial pentavalente

Um caso de leishmaniose cutâneo-mucosa tratado com sucesso com baixa dose de antimonial pentavalente

Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

Glucantime resistant Leishmania promastigotes are sensitive to pentostam

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