Comparison between systemic and intralesional meglumine antimoniate therapy in a primary health care unit

Duque, Maria Cristina de Oliveira; Silva, José Jayme Quintão; Soares, Priscilla Andrade Oliveira; Magalhães, Rodrigo; Horta, Adriene Paiva Araújo; Paes, Lucia Regina Brahim; Lyra, Marcelo Rosandiski; Pimentel, Maria Inês Fernandes; Antônio, Liliane de Fátima; Vasconcellos, Érica de Camargo Ferreira e; Saheki, Maurício Naoto; Marzochi, Mauro Célio de Almeida; Valete‐Rosalino, Cláudia Maria; Schubach, Armando de Oliveira

doi:10.1016/j.actatropica.2019.03.007

Cited by 18 publications

(20 citation statements)

References 32 publications

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“…However, the safety of the AR and IL regimens endorsed their use. The cure rates achieved with AR and IL infiltration were similar to those observed with standard treatments with MA according to other authors in Brazil [20,21] and in the American continent [23].…”

Section: Discussionsupporting

confidence: 86%

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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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Section: Discussionsupporting

confidence: 86%

“…Treatment of CL with AR and intralesional infiltrations of MA showed good efficacy and low toxicity as observed in other studies [15,16,20,21,22], even as rescue schemes used after interruption of the treatment due to AE related to other regimens with the same medication.…”

Section: Discussionsupporting

confidence: 70%

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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“…O método intralesional veio para revolucionar a saúde local, onde a saúde é precária e de difícil acesso, pois teve sua eficácia comprovada com eficiência e rapidez utilizando uma quantidade menor da droga obtendo um resultado de desaparecimento TOTAL da lesão 12,13 .…”

Section: Discussionunclassified

Tratamento na atenção básica de leishmaniose cutânea com aplição intralesional de glucantime em região da face

Wanderley

Veloso

Monção

2021

SaudColetiv (Barueri)

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A leishmaniose tegumentar americana é uma doença infecciosa endêmica na saúde pública do país. A doença é transmitida após a picada das fêmeas do mosquito hematófago, conhecido como flebotomíneo e possui diversas manifestações clínicas, classificadas em cutânea, cutaneomucosa e cutânea difusa, acometendo todas os gêneros e faixas etárias. O objetivo desse artigo é relatar o caso clínico de um paciente, apresentando lesão ulcerada em região da face. O método utilizado foi a identificação de Leishmania através da reação em cadeia da polimerase associada a resposta clínica ao tratamento após aplicação intralesional. Como resultado foram obtidas respostas imediatas das lesões que apesar de estudos apresentarem cura espontaneamente após meses/anos, lesões faciais necessitam de um protocolo mais agressivo. Conclui-se que a importância do relato se deve ao fato do tratamento terapêutico consistir a aplicação direta em local não liberado pelo protocolo do Ministério da Saúde de leishmaniose tegumentar americana.

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“…When intralesional MA is chosen for therapy, 5 mL are applied subcutaneously at 15-day intervals, even in lesions larger than 3 cm. Clearance is achieved in 66.7 % of the cases compared to systemic administration (68.4 %) [8]. In L. braziliensis the combination of the drug with lidocaine, besides resulting in diminished pain, is associated with fragmentation and loss of morphologic definition of the plasmatic membrane and organelles of the protozoa [9].…”

Section: Correspondence Clinical Lettermentioning

confidence: 99%

Localized leishmaniasis treated with intralesional meglumine antimoniate

Villela-Segura¹,

Proy‐Trujillo

Ilizaliturri‐Flores

et al. 2020

J Deutsche Derma Gesell

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Comparison between systemic and intralesional meglumine antimoniate therapy in a primary health care unit

Cited by 18 publications

References 32 publications

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

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

Tratamento na atenção básica de leishmaniose cutânea com aplição intralesional de glucantime em região da face

Localized leishmaniasis treated with intralesional meglumine antimoniate

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