Estudo clínico randomizado comparando antimoniato de meglumina, pentamidina e anfotericina B para o tratamento da leishmaniose cutânea ocasionada por Leishmania guyanensis

Neves, Leandro Ourives; Talhari, Anette Chrusciak; Gadelha, Ellen Priscilla Nunes; Júnior, Roberto Moreira da Silva; Guerra, Jorge Augusto de Oliveira; Ferreira, Luíz Carlos de Lima; Talhari, Sinésio

doi:10.1590/s0365-05962011000600005

Cited by 93 publications

(56 citation statements)

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“…We identified 1865 references of interest (Figure 1) through the literature search and deemed relevant 16 studies on CL or ML [69]–[84]. We included and analyzed 10 new RCTs (Table 1); excluded references are available in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Four RCTs were conducted in Brazil [69], [72]–[74], four in Colombia [70], [71], [75], [81], one in Bolivia [77], and Peru [76]. The Leishmania species responsible for infection were identified in most studies (Table 1) [69]–[77], [81] The follow-up time ranged from 3 months to 1 year. Six references did not comply with eligibility criteria and were excluded [78]–[80], [82]–[84].…”

Section: Resultsmentioning

confidence: 99%

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Interventions for American Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review Update

et al. 2013

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IntroductionLeishmaniasis is an important public health problem in the Americas. A Cochrane review published in 2009 analyzed 38 randomized controlled trials (RCT). We conducted a systematic review to evaluate the effects of therapeutic interventions for American cutaneous and mucocutaneous leishmaniasis.MethodsAll studies were extracted from PubMed, Embase, Lilacs (2009 to July, 2012 respectively), the Cochrane Central Register of Controlled Trials (6-2012) and references of identified publications. RCTs’ risk of bias was assessed.ResultsWe identified 1865 references of interest; we finally included 10 new RCTs. The risk of bias scored low or unclear for most domains. Miltefosine was not significantly different from meglumine antimoniate in the complete cure rate at 6 months (4 RCT; 584 participants; ITT; RR: 1.12; 95%CI: 0.85 to 1.47; I2 78%). However a significant difference in the rate of complete cure favoring miltefosine at 6 months was found in L. panamensis and L. guyanensis (2 RCTs, 206 participants; ITT; RR: 1.22; 95%CI: 1.02 to 1.46; I2 0%). One RCT found that meglumine antimoniate was superior to pentamidine in the rate of complete cure for L. braziliensis (80 participants, ITT; RR: 2.21; 95%CI: 1.41 to 3.49), while another RCT assessing L. guyanensis did not find any significant difference. Although meta-analysis of three studies found a significant difference in the rate of complete cure at 3 months favoring imiquimod versus placebo (134 participants; ITT; RR: 1.45; 95%CI: 1.12 to 1.88; I2 0%), no significant differences were found at 6 and 12 months. Thermotherapy and nitric oxide were not superior to meglumine antimoniate.ConclusionTherapeutic interventions for American cutaneous and mucocutaneous leishmaniasis are varied and should be decided according to the context. Since mucosal disease is the more neglected form of leishmaniasis a multicentric trial should be urgently considered.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions for American Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review Update

et al. 2013

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“…Cutaneous leishmaniasis (CL) manifests as a localized solitary or multiple lesions on the face, head, neck and extremities (2,3) that can become chronic, leading to significant tissue destruction and disfigurement. In 98 countries worldwide, 350 million people are at risk of CL disease, the majority of who are residing in developing countries (1,4).…”

Section: Introductionmentioning

confidence: 99%

Meglumine antimoniate is more effective than sodium stibogluconate in the treatment of cutaneous leishmaniasis

Yeşilova¹,

Sürücü

Ardıç

et al. 2015

Journal of Dermatological Treatment

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Sodium stibogluconate (SSG, Pentostam) and meglumine antimoniate (MA, Glucantime) are two antimonials that are widely used to treat cutaneous leishmaniasis (CL), but the relative efficacies of these treatments are not clear. The aim of this study is to compare the efficacy of intralesional SSG with intralesional MA therapy in the treatment of CL. One month after completion of the therapy, 1431 of 1728 patients (82%) who received intralesional MA showed complete clinical cure compared to 1157 of 1728 patients (67%) in the SSG group. Patients who did not respond to the first round of therapy were re-administered the same treatment but with twice weekly injections. Following completion of the second course of therapy, 237 of 297 patients (80%) in the MA group and 407 of 561 patients (72%) in the SSG group healed their lesions by 1-month post-treatment. At both times, the differences in cure rates between MA and SSG groups were statistically significant (p<0.05). Cure rates in the MA group were always significantly higher than SSG groups irrespective of other parameters including age, gender, lesion site and type of lesion. Intralesional MA is more effective than intralesional SSG in the treatment of CL.

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“…148, 149 However cure rates were lower for L. guyanensis infection in Brazil. 150 In another study from French Guiana, a single injection of pentamidine isethionate, at 7 mg/kg cured 78.8% as compared to 83.6% of two such injections (given 48 h apart). 151 In Columbia CL due to L. panamensis 2mg pentamidine isethionate/kg, administered every other day in seven injections, was 95% curative.…”

Section: Review Of Antileishmanial Agentsmentioning

confidence: 96%

An update on pharmacotherapy for leishmaniasis

Sundar

Chakravarty

2014

Expert Opinion on Pharmacotherapy

239

191

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Introduction Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL). The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic. Areas covered A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sbv) and paromomycin remains the treatment of choice for East African VL. L-AmB is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. Expert opinion There is an urgent need to implement a single dose L-AmB or combination therapy in the Indian subcontinent. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend towards local treatment for New World CL (NWCL) is preferred in patients without risk of mucosal disease.

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Estudo clínico randomizado comparando antimoniato de meglumina, pentamidina e anfotericina B para o tratamento da leishmaniose cutânea ocasionada por Leishmania guyanensis

Cited by 93 publications

References 18 publications

Interventions for American Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review Update

Interventions for American Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review Update

Meglumine antimoniate is more effective than sodium stibogluconate in the treatment of cutaneous leishmaniasis

An update on pharmacotherapy for leishmaniasis

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