Transient Success Using Prolonged Treatment with Miltefosine for a Patient with Diffuse Cutaneous Leishmaniasis Infected with Leishmania mexicana mexicana

Ordáz-Farías, Alejandro; Muñoz-Garza, Fania Zamantta; Sevilla-Gonzalez, Farah K.; Arana-Guajardo, Ana Cecilia; Ocampo‐Candiani, Jorge; Treviño-Garza, Nancy; Becker, Ingeborg; Camacho-Ortíz, Adrián

doi:10.4269/ajtmh.2012.11-0592

Cited by 14 publications

(8 citation statements)

References 19 publications

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“…Therefore, strengthening the correct protective immunity development by combining miltefosine treatment with another immunomodulatory drug could improve outcomes in order to achieve stable and sterile cure and also decrease chance of developing resistance to miltefosine. Similar calls were raised by other groups [ 34 , 35 ], and a similar approach is being used for VL, where patients are only given miltefosine as combination therapy in East Africa.…”

Section: Discussionmentioning

confidence: 81%

“…Similar results were observed in other case series in Latin America, which showed an initial good response in PLOS NEGLECTED TROPICAL DISEASES (mostly DCL) patients followed by relapse after treatment cessation. Extending miltefosine from four to six weeks did not increase cure rates for CL [32], and also does not seem to prevent relapse [33][34][35]; as one study showed that 15/16 DCL patients eventually relapsed, despite treatment of at least 75 days. For three of our study patients, the physician also decided to extend to a total of six weeks of miltefosine, but all of these patients still relapsed at day 180.…”

Section: Discussionmentioning

confidence: 93%

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Miltefosine for the treatment of cutaneous leishmaniasis—A pilot study from Ethiopia

et al. 2021

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Background Cutaneous leishmaniasis (CL) in Ethiopia, caused by Leishmania aethiopica, is often severe and hard to treat compared to CL caused by other species elsewhere. Miltefosine is the only oral anti-leishmanial drug, with a favorable side-effect profile compared to routinely available sodium stibogluconate (SSG), but evidence about its use for L. aethiopica is lacking. Methodology and principal findings In an observational cohort study, treatment outcomes, safety and adherence among CL patients who required systemic treatment and received miltefosine for 28 days in Boru Meda Hospital and University of Gondar Hospital were studied. Patient cure was defined as 100% flattening for non-ulcerated lesions and 100% flattening and 100% re-epithelization for ulcerated lesions. Outcomes were documented for day 28, 90 and 180, both per site, and pooled, adjusting for site as a fixed effect with effect coding. Among 94 included patients (32 in Gondar, 62 in Boru Meda), median lesion duration was 12 months, median size six cm, and mucosal involvement (46.8%) and diffuse (30.9%) lesions were common. Adherence to miltefosine was good, and side-effects were tolerable. Initial outcomes at day 28 were promising, with 68.8% and 94.0% of patients having good improvement or cure in Gondar and Boru Meda respectively. In Boru Meda, outcomes were good with 72.7% and 72.9% cure at day 90 and day 180 respectively. In Gondar, results were less promising, with only 12.5% and 26.7% cure at day 90 and day 180, although confidence intervals were wide. In pooled estimates, 48.7% of patients reached cure at day 180, and 32.3% relapsed. Outcomes were better in Boru Meda Hospital, for smaller lesions and for mucosal lesions. Conclusions/Significance Based on miltefosine’s good initial response, tolerable side-effects, tablet-form, we propose to include miltefosine for future clinical trials using extended treatment schedules, combination therapy, or targeting specific subgroups. Trial registration ClinicalTrials.gov NCT04004754.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 93%

Miltefosine for the treatment of cutaneous leishmaniasis—A pilot study from Ethiopia

et al. 2021

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“…Anfotericina B que posee efectividad moderada a dosis de 0.5-1 mg/kg por vía parenteral hasta 8 semanas [22]. Miltefosina por vía oral a dosis de 2.5 mg/kg al día [23], otros posibles tratamientos son la termoterapia y crioterapia, el Imiquimod Tópico [24,25]. Pentoxifilina en asociación a N-metilglucamina efectivo en casos de mala respuesta a los antimoniales.…”

Section: Discussionunclassified

Leishmaniasis cutánea, a propósito de un caso.

Mosquera

Díaz

2019

RFCM

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La Leishmaniasis es una enfermedad parasitaria catalogada como emergente y sin control debido al cambio en el perfil epidemiológico por el surgimiento de nuevos focos y urbanización del ciclo de transmisión. Se describe el caso de un adolescente de la Comunidad Dos Ríos, del Cantón Taisha, quien presentó varias lesiones ulceradas, confirmándose diagnóstico de Leishmaniasis Cutánea mediante estudio histológico, iniciándose tratamiento con sales de antimonio pentavalentes, logrando una resolución progresiva y paulatina de las lesiones. Destacándose la importancia del diagnóstico temprano, tratamiento supervisado, y seguimiento para prevenir complicaciones. Palabras clave: leishmaniasis cutánea, enfermedades cutáneas parasitarias/complicaciones, población rural, adolescente, gluconato de sodio antimonio.

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“…121 All these studies suggest that miltefosine could be an alternative option for the treatment of CL and ML in these region however treatment of diffuse cutaneous leishmaniasis has not been encouraging. 122-124 …”

Section: Review Of Antileishmanial Agentsmentioning

confidence: 99%

An update on pharmacotherapy for leishmaniasis

Sundar

Chakravarty

2014

Expert Opinion on Pharmacotherapy

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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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Transient Success Using Prolonged Treatment with Miltefosine for a Patient with Diffuse Cutaneous Leishmaniasis Infected with Leishmania mexicana mexicana

Cited by 14 publications

References 19 publications

Miltefosine for the treatment of cutaneous leishmaniasis—A pilot study from Ethiopia

Miltefosine for the treatment of cutaneous leishmaniasis—A pilot study from Ethiopia

Leishmaniasis cutánea, a propósito de un caso.

An update on pharmacotherapy for leishmaniasis

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