Imiquimod in Combination With Meglumine Antimoniate for Cutaneous Leishmaniasis

Abstract

Setting: Two primary care health clinics.Patients: One hundred nineteen patients (59 patients in the imiquimod group and 60 in the placebo group) were included in the study.Interventions: Patients were randomly assigned to receive a combined 4-week course of imiquimod or placebo with meglumine antimoniate treatment (20 mg/kg of pentavalent antimony daily for 2 weeks) in an endemic area of Leishmania tropica. Main Outcome Measures:The primary end point was clinical cure, defined as more than 75% reduction in the size of lesions compared with baseline at week 8.Results: At the end of the 4-week treatment period, clinical cure was similar in both groups (11 patients [18.6%] in the imiquimod-treated group vs 18 patients [30.0%] in the placebo group) (P =.15). Four weeks after the end of treatment, 26 patients (44.1%) and 29 patients (48.3%) in the imiquimod-treated and placebo groups, respectively, were cured (P=.64). Pruritus and burning sensation were reported by 3 patients treated with imiquimod and by no patients treated with placebo. Conclusion:This study showed no beneficial effect of combining a 4-week course of treatment with 5% imiquimod cream and a standard course of treatment with meglumine antimoniate in patients with cutaneous leishmaniasis in an endemic area of L tropica.

Cationic liposomes containing soluble Leishmania antigens (SLA) plus CpG ODNs induce protection against murine model of leishmaniasis

“…Controls strategies are not always successful; available drugs need multiple injections and practically show a limited efficacy in some endemic areas (Croft et al 2006;Firooz et al 2006;Santos et al 2008). For centuries, it is well known that longlasting protection induces upon recovery from CL caused by natural infection or leishmanization .…”

Systemic Meglumine Antimoniate in Acute Cutaneous Leishmaniasis: Children versus Adults

“…9,10 In general, the average improvement in lesion size is considered as 60-80%. 11 Resistance to Sb v for L. tropica has been reported in several endemic regions of Iran 9,12 ; Faghihi and others 13 reported 41.7% improvement in CL lesions in the central part of Iran, whereas in another study 34.5% improvement in lesion size was reported in the northeast of this country. 14 On the other hand, there is some evidence indicating different response rates to this medication in children.…”

Topical Treatment Modalities for Old World Cutaneous Leishmaniasis: A Review

“…Other reports in old world cutaneous leishmaniasis confirmed treatment failure when topical imiquimod cream used alone and its additive effect when used in association with antimony compounds (Arevalo et al, 2001;Seeberger et al, 2003). In another study, no beneficial effect was reported with combination therapy of imiquimod and MG against L. tropica (Firooz et al, 2006). Immunotherapy of L. major-infected mice, with imiquimod combined with MG chemotherapy showed the efficacy higher than that of imiquimod alone (Khalili et al, 2011).…”