Miltefosine for New World Cutaneous Leishmaniasis

Abstract

The oral agent miltefosine has demonstrated a >95% cure rate in Indian visceral leishmaniasis. We performed a large, placebo-controlled study of miltefosine therapy (2.5 mg/kg per day orally for 28 days) against cutaneous leishmaniasis in Colombia and Guatemala. In regions in Colombia where Leishmania vianna panamensis is common, the per-protocol cure rates for miltefosine and placebo were 91% (40 of 44 patients) and 38% (9 of 24). These values are similar to historic values for the antimony standard of care and placebo. In regions in Guatemala where L. v. braziliensis and L. mexicana mexicana are common, the per-protocol cure rates were 53% (20 of 38) for miltefosine and 21% (4 of 19) for placebo. The miltefosine rate was lower than historic antimony cure rates of >90%. Miltefosine was well tolerated. Miltefosine is a useful oral agent against cutaneous leishmaniasis due to L. v. panamensis in Colombia but not against leishmaniasis due to L. v. braziliensis in Guatemala.

Thermoterapy effective and safer than miltefosine in the treatment of cutaneous leishmaniasis in Colombia

“…The differences in therapeutic response in the previous study in Colombia and Guatemala were attributed to the species of Leishmania predominant in each country 22 . The data for Colombia, however, was mainly based on historical records, given that only seven isolated strains were identified in the study from the 73 study participants, and all were identified as L. (V.) panamensis.…”

Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

“…Miltefosine was effective in curing patients with visceral leishmaniasis in India; however, few studies on the treatment of tegumentary leishmaniasis have been reported. In Colombia, a cure rate of 89-100% was observed for cutaneous leishmaniasis and was dependent on the dose used [86]; however, in general, the results in the New World are poor [87].…”

Failure of both azithromycin and antimony to treat cutaneous leishmaniasis in Manaus, AM, Brazil

“…without conclusive results (DOGRA & SAXENA, 1996;ALRAJHI et al, 2002). Recently, patients with cutaneous leishmaniasis caused by L. (Viannia) panamensis in Colombia received miltefosine and presented cure rate of 91%, whereas, in Guatemala, only 50% of cure was obtained in patients infected by L. (Viannia) brasiliensis (SOTO et al, 2004). The results in patients with visceral leishmaniasis in India also showed good efficacy (93%) with this drug (SUNDAR et al, 2002).…”