Levamisole as an Adjuvant to Short-Course Therapy in Newly Diagnosed Pulmonary Tuberculosis Patients

Abstract

Background:The estimated incidence and prevalence of tuberculosis in India are 2.1 and 2.6 million cases respectively. Immunotherapy may shorten tuberculosis treatments and improve the immunity of individuals as well. Hence we study the efficacy of levamisole (LVM) (immunomodulator) as an adjuvant to chemotherapy of pulmonary tuberculosis patients.Materials and Methods:A randomized, double-blind, placebo-controlled clinical trial was conducted for 21 months in newly diagnosed sputum positive pulmonary tuberculosis patients. Patients were subjected initially to clinical examination, sputum acid-fast bacilli smear and culture, tuberculin skin test and weight record. During follow-up, above investigations were repeated. Sixty-five patients were randomly assigned into two groups to receive either tab LVM 100 mg once in a day or matching placebo, orally as a single dose, thrice a week, for 2 months with short-course antituberculosis chemotherapy.Results:Sputum negativity at 1 week was observed in 11 (44%) patients in LVM group whereas only 3 (12%) in placebo group. All the patients 25 (100%) in LVM group were sputum negative compared to 14 (56%) in placebo group by the end of 3 weeks. In LVM group, 24 (96%) and 11 (44%) patients in placebo group show radiological improvement at 2 months. A direct correlation existed between quantum of immune response and weight gain with LVM. LVM rendered all anergic patients to positive tuberculin reactors. In LVM group, patients with initial Mantoux ≥20 mm and advanced cavitary disease, there was decrease in tuberculin reaction size.Conclusion:Adjuvant immunomodulation with levamisole has the potential of shortening the total duration of antitubercular therapy.

DARK Classics in Chemical Neuroscience: Aminorex Analogues

“…The anthelmintic drug levamisole is mostly used for veterinary purposes but was originally also intended for use in humans. − It is currently still being used for treatment in countries where the incidence of helminthiasis in humans is high across the population . New indications, such as the treatment of the steroid-sensitive idiopathic nephrotic syndrome, colorectal cancer, various dermatologic conditions, pulmonary tuberculosis, recurrent aphthous stomatitis, and severe aplastic anemia, have been explored. − Illicitly, levamisole is being used as an adulterant in street samples of cocaine. This practice has been increasingly reported from the onset of the new millennium onward both in the United States and Europe. , In the beginning, the use of levamisole as an adulterant was considered enigmatic .…”

The advances in adjuvant therapy for tuberculosis with immunoregulatory compounds

“…The Brown Norway rats injected intraperitoneally with levamisole showed a marked upregulation of IL-18 and enhancement of Th1 immune response ( Szeto et al, 2000 ). Clinical oral levamisole adjuvant treatment of TB and bone TB patients could ameliorate the clinical symptoms, improve the body’s immune functions, and promote the absorption of lesions and negative conversion of sputum bacteria, but may cause gastrointestinal discomfort, allergy, headache, fever, dizziness and other adverse reactions ( Mielants and Veys, 1978 ; Qiu et al, 2002 ; Guo, 2008 ; Shamkuwar et al, 2017 ; Saurabh et al, 2018 ). However, detailed pharmacokinetic data from large number of subjects are lacking.…”

Selective [3 + 2] cycloaddition reaction of isothiazol‐3(2h)‐ones with in situ formed azomethine ylide to thiazolidines and oxazolidines

“…Thiazolidine derivatives are extraordinarily important compounds found in natural products as bioactive molecules with promising antiproliferative, anthelmintic, and antimicrobial activities, such as Levamisole [36–43], Teneligliptin [44–46], RP66681 [47], and YM461 [48–50]. (Figure 1) These compounds have received increasing attention all over the world due to their medicinal value.…”

“…Thiazolidine derivatives are extraordinarily important compounds found in natural products as bioactive molecules with promising antiproliferative, anthelmintic, and antimicrobial activities, such as Levamisole [36][37][38][39][40][41][42][43], Teneligliptin [44][45][46], RP66681 [47], and YM461 [48][49][50].…”