Oral Miltefosine for Leishmaniasis in Immunocompromised Patients: Compassionate Use in 39 Patients with HIV Infection

Sindermann, H.; Engel, Kirsten; Fischer, Christina; Bommer, W; Program, Miltefosine Compassionate Use

doi:10.1086/425359

Cited by 102 publications

(53 citation statements)

References 11 publications

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“…These patients present more serious and frequent side effects than patients infected only with Leishmania (Delgado et al 1999). Their response to treatment is also poor: antimonials, amphotericin B deoxycholate and amphotericin B lipid complex are showing an effectiveness of around 60-70% (Laguna 2003), and similar figures have been reported for miltefosine (Sindermann et al 2004). …”

Section: Discussionmentioning

confidence: 77%

Drug policy for visceral leishmaniasis: a cost‐effectiveness analysis

Vanlerberghe

Diap

Guérin³

et al. 2007

Tropical Med Int Health

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Summaryobjective To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first-line health services in (VL)-endemic areas, we compared in a formal decision analysis the cost and the costeffectiveness of the different available options.methods We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The point estimates and the range of plausible values of effectiveness and cost were retrieved from a literature review. A decision tree was constructed and the strategy minimizing the cost per death averted was selected.results Treatment with amphotericin B deoxycholate was the most effective approach in the baseline analysis and averted 87.2% of all deaths attributable to VL. The least expensive and the most costeffective treatment was the miltefosine regimen, and the most expensive and the least cost-effective was AmBisome Ò treatment. The cost of drug and medical care are the main determinants of the costeffectiveness ranking of the alternative schemes. Sensitivity analysis showed that antimonial was competitive with miltefosine in the low-resistance regions.conclusion In areas with >94% response rates to antimonials, generic sodium stibogluconate remains the most cost-effective option for VL treatment, mainly due to low drug cost. In other regions, miltefosine is the most cost-effective option of treatment, but its use as a first-line drug is limited by its teratogenicity and rapid resistance development. AmBisome in mono-or combination therapy is too expensive to compete in cost-effectiveness with the other regimens.keywords visceral leishmaniasis, drug policy, cost-effectiveness analysis

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Section: Discussionmentioning

confidence: 77%

Drug policy for visceral leishmaniasis: a cost‐effectiveness analysis

Vanlerberghe

Diap

Guérin³

et al. 2007

Tropical Med Int Health

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“…Cure rates of 95% and 94% were achieved after oral administration in phase II and phase III trials in Indian patients, leading to its registration in India in 2002 (17,44). In a compassionate-use program involving 39 patients with human immunodeficiency virus-leishmaniasis coinfection, initial parasitological cure was observed in 41% of patients (41). Although miltefosine has the advantage of being an effective oral drug, its use in women of child-bearing age is restricted due to teratogenicity, which has been observed in one species (rat) with a no-effect dose level of 0.6 mg/kg.…”

mentioning

confidence: 99%

In Vitro and In Vivo Interactions between Miltefosine and Other Antileishmanial Drugs

Seifert

Croft

2006

Antimicrob Agents Chemother

181

119

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“…Mitelfosine, an alkylphosphocholine with antileishmanial activity, was used as an alternative treatment in his second episode of relapse. Studies in immunocompromised patients (human immunodeficiency virus seropositive) have shown that the antileishmanial activity of this drug is retained in this special population, suggesting that mitelfosine might be a useful option in preventing relapses of the disease [13]. Unfortunately, even after mitelfosine therapy, our patient had a new episode of VL.…”

Section: Discussion:-mentioning

confidence: 79%

Recurrent Visceral Leishmaniasis in an Immunocompetent Patient: A Case Report.

Bosily¹,

AwadR²,

MadallahT³

et al. 2017

IJAR

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Introduction:-Current treatment options for visceral leishmaniasis (pentavalent antimony, amphotericin B, liposomal amphotericin B and mitelfosine) achieve long-term clinical cure in the majority of immunocompetent patients. Disease relapse is usually provoked by Tcell number or function impairment (corticosteroid or cytotoxic therapy, transplant recipients, advanced human immunodeficiency virus disease). Case presentation:-We report a case of visceral leishmaniasis with multiple relapses in a 75-year-old Greek immunocompetent man. Visceral leishmaniasis relapses occurred despite appropriate treatment with liposomal amphotericin B 3mg/kg/day on days one to five, 14 and 21 (for the first episode and the first relapse) and mitelfosine 150mg/day for 28 days (for the second relapse). The third relapse was treated with high-dose liposomal amphotericin B (10mg/kg for two consecutive days), followed by a secondary prophylaxis of 3mg/kg once per month, which prevented disease reappearance during one year of follow-up. Conclusion:-An unusual case of recurrent visceral leishmaniasis in an older immunocompetent patient was treated with high-dose liposomal amphotericin B and a monthly prophylaxis with no evidence of a relapse after one year of follow-up.

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Oral Miltefosine for Leishmaniasis in Immunocompromised Patients: Compassionate Use in 39 Patients with HIV Infection

Cited by 102 publications

References 11 publications

Drug policy for visceral leishmaniasis: a cost‐effectiveness analysis

Drug policy for visceral leishmaniasis: a cost‐effectiveness analysis

In Vitro and In Vivo Interactions between Miltefosine and Other Antileishmanial Drugs

Recurrent Visceral Leishmaniasis in an Immunocompetent Patient: A Case Report.

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