Intravenous Liposomal Amphotericin B Efficacy and Safety for Cutaneous and Mucosal Leishmaniasis: A Systematic Review and Meta-analysis

Abstract

Background Tegumentary leishmaniasis is often subject to limited funding, underpowered studies and a paucity of high-quality interventional studies. Intravenous liposomal amphotericin B (L-AmB) has been increasingly used to treat cutaneous and mucosal leishmaniasis (CL and ML respectively) despite the lack of well-conducted interventional studies. We conducted a systematic review to consolidate the descriptive evidence on the efficacy and safety of L-AmB in treating CL and ML. Methods Several online databases and the reference lists of included studies were searched to extract data from 132 studies comprising of both case reports and case series. The population, intervention, comparison, outcome and study design strategy and the preferred reporting items for systematic reviews and meta-analyses guidelines were used. Results Of 132 studies included, 92 were case reports and 40 were case series. Of the 92 cases, 65 (82.3%) were considered cured after receiving L-AmB as part of their treatment regimen. 21 of the 92 (22.8%) cases reported adverse reactions to L-AmB. A pooled cure rate of 87.0% (CI95%:79.0%-92.0%) was reported for the 38 case series that reported on treatment efficacy. 40.7% of the cases were associated with an adverse reaction. Conclusions Observational data on cure rates using L-AmB suggests efficacy between 80 and 90%, similar to rates reported for other anti-leishmanial drugs. The highest efficacy rates were observed when a single cycle of L-AmB was administered to patients with mild-moderate CL and ML. The limitations of this study include the heterogeneity observed among the included studies and the increased likelihood of publication bias associated with the inclusion of case reports and case series.This systematic review further illustrates the need for high-quality comparative trials of IV L-AmB for the treatment of tegumentary leishmaniasis.

Review of Leishmaniasis Treatment: Can We See the Forest through the Trees?

“…Intravenous liposomal amphotericin B cure rates suggest efficacy of 80 to 90% for MCL, similar to rates reported for other antileishmanial drugs (i.e., pentavalent antimonial compounds) [52].…”

Mucosal Relapse of Visceral Leishmaniasis in a Child with SARS-CoV-2 Infection

“…gold standard treatment of leishmaniasis for decades [7,8], lipid formulations of amphotericin B, and particularly liposomal amphotericin B, are considered today as the treatment of choice for VL in many regions [9,10], and data have proved this efficacy and safety, even for cutaneous and mucocutaneous leishmaniasis [11].…”

“…If left untreated, the disease can eventually lead to death, while adequate treatment usually leads to full recovery. Even if antimonial compounds have been considered the gold standard treatment of leishmaniasis for decades [7,8], lipid formulations of amphotericin B, and particularly liposomal amphotericin B, are considered today as the treatment of Pathogens 2023, 12, 1127 2 of 8 choice for VL in many regions [9,10], and data have proved this efficacy and safety, even for cutaneous and mucocutaneous leishmaniasis [11].…”

American Cutaneous Leishmaniasis: Imported cases in Berlin 2000–2023

“…Treatment of CL with LAmB is mostly based on its efficacy in treating visceral leishmaniasis (VL). Consequently, the dosages are aligned to the VL regimen (total cumulative dose of 21mg/kg) [ 21 ], but the skin penetration of LAmB is not well studied and efficacy data for use of LAmB therapy for CL is primarily based on results from small, mostly observational studies that have shown various cure rates [ 22 – 26 ]. One recent retrospective cohort study in an L .…”

“…braziliensis endemic area in Brazil compared the efficacy of LAmB with IV pentavalent antimony (meglumine antimoniate), and found that patients treated with meglumine antimoniate had a cure rate of 93.9% compared to a cure rate of 57.6% in the LAmB group [ 25 ]. In a recent systematic review of CL cases and case series primarily from South America that were treated with LAmB, an overall treatment efficacy of 82.3% was calculated [ 21 ].…”