Mucosal leishmaniasis: the experience of a Brazilian referral center

Pedras, Mariana Junqueira; Carvalho, Janaína de Pina; Silva, Rosiana Estéfane da; Ramalho, Dario Brock; Senna, Maria Camilo Ribeiro de; Moreira, Herculano; Martinho, Lorena Zaine Matos; Rabello, Ana; Cota, Gláucia

doi:10.1590/0037-8682-0478-2017

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…In general, the authors used the terms “relapse” or “recurrence” indistinctly. In 11 studies, the condition was defined as the reappearance of the activity of an already healed mucosa [ 27 , 28 , 31 , 33 , 36 , 41 , 42 , 45 , 46 , 50 , 51 ]. For three studies, relapse could occur after incomplete healing [ 42 , 45 , 50 ], and for the other five studies, relapse could be new lesion onset [ 27 , 28 , 31 , 33 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…In 11 studies, the condition was defined as the reappearance of the activity of an already healed mucosa [ 27 , 28 , 31 , 33 , 36 , 41 , 42 , 45 , 46 , 50 , 51 ]. For three studies, relapse could occur after incomplete healing [ 42 , 45 , 50 ], and for the other five studies, relapse could be new lesion onset [ 27 , 28 , 31 , 33 , 45 ]. Time for cure assessment and follow-up varied widely among studies and the initial date from which the follow-up accounting starts was not a consensus among the authors, some counting from the first and others from the last day of treatment.…”

Section: Resultsmentioning

confidence: 99%

“…ML severity was classified using different criteria across the studies. The Llanos-Cuentas (1997) classification [ 42 ], which combines mucosal lesion extension and severity of symptoms, was used in five studies [ 31 , 33 , 39 , 42 , 50 ]. In turn, Soto’s (2007) [ 48 ] classification was adopted in three studies [ 32 , 48 , 52 ] and Lessa’s classification (2012) [ 54 ] was used in two others [ 30 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…The cure and relapse rates described by each study at different times after the start of treatment are shown in Table 3. Taking as a model the outcomes harmonization for CL studies [14,55], it was possible to gather 12 studies [30,31,34,38,40,41,44,45,49,51,53] reporting cure at D90 (meaning cure assessment between 60 and 135 days from the beginning of treatment), 10 studies [26,[29][30][31]34,37,[44][45][46]53] presenting cure at D180 (cure assessment between 136 and 270 days from the beginning of treatment) and 16 studies [27][28][29][31][32][33]36,37,[41][42][43][44][45]47,48,51,52] presenting cure at D360 (cure assessment between 271 and 390 from the beginning of treatment).…”

Section: Discussionmentioning

confidence: 99%

“…Most studies were conducted in Brazil (17 studies), and the other countries were Bolivia (3), Peru (4), Argentina (1), Panama (1) and Ecuador (1). In total, 1,666 patients with ML were gathered, and the interventions evaluated were pentavalent antimonials [26][27][28][29], both meglumine antimonate (MA) [29][30][31][32][33][34][35][36][37][38][39][40] and sodium stibogluconate (SSG) [29,[41][42][43][44][45]; different lipid formulations of amphotericin, such as liposomal preparation (L-AMB), a lipid complex (ABLC) and a colloidal dispersion (c-AMB) [28,31,33,46,47] and deoxycholate amphotericin B (d-AMB) [28,33,48,49]; aminosidine sulfate (AS) [50,51]; pentamidine (PENT) [28,33]; miltefosine (MF) [30,32,48,52]; imidazoles (IMIDZ) [26,28,31,33,53]; and few combined therapies based on antimony derivatives and sulfa...…”

Section: Studies and Population Characteristicsmentioning

confidence: 99%

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The cure rate after different treatments for mucosal leishmaniasis in the Americas: A systematic review

et al. 2022

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Background Mucosal or mucocutaneous leishmaniasis is the most severe form of tegumentary leishmaniasis due to its destructive character and potential damage to respiratory and digestive tracts. The current treatment recommendations are based on low or very low-quality evidence, and pentavalent antimonial derivatives remain strongly recommended. The aim of this review was to update the evidence and estimate the cure rate and safety profile of the therapeutic options available for mucosal leishmaniasis (ML) in the Americas. Methodology A systematic review was conducted in four different databases and by different reviewers, independently, to evaluate the therapeutic efficacy and toxicity associated with different treatments for ML. All original studies reporting cure rates in more than 10 patients from American regions were included, without restriction of design, language, or publication date. The risk of bias was assessed by two reviewers, using different tools according to the study design. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. The protocol for this review was registered at the International Prospective Register of Systematic Reviews, PROSPERO: CRD42019130708. Principal findings Twenty-seven original studies from four databases fulfilled the selection criteria. A total of 1,666 patients with ML were treated predominantly with pentavalent antimonials in Brazil. Other interventions, such as pentamidine, miltefosine, imidazoles, aminosidine sulfate, deoxycholate and lipidic formulations of amphotericin B (liposomal, lipid complex, colloidal dispersion), in addition to combinations with pentoxifylline, allopurinol or sulfa were also considered. In general, at least one domain with a high risk of bias was identified in the included studies, suggesting low methodological quality. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. It was confirmed that antimony is still the most used treatment for ML, with only moderate efficacy (possibly increased by combining with pentoxifylline). There is already evidence for the use of miltefosine for ML, with a cure rate similar to antimony, as observed in the only direct meta-analysis including 57 patients (OR: 1.2; 0.43–3.49, I2 = 0). It was possible to gather all descriptions available about adverse events reported during ML treatment, and the toxicity reflected the pattern informed in the manufacturers’ technical information. Conclusions This study provides an overview of the clinical experience in the Americas related to ML treatment and points out interventions and possible combinations that are eligible to be explored in future well-designed studies.

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