Tehran University Medical Journal (Sep 2020)
Factors affecting the antimonial treatment duration rate in patients with cutaneous leishmaniasis: survival analysis model
Abstract
Background: Currently, cutaneous leishmaniasis (CL) as a parasitic disease is treated with Glucantime and Pentostam in most of the endemic countries. This study aimed to identify factors affecting the glucantime therapy duration rate in patients with CL using a survival analysis model. Methods: This retrospective descriptive-analytic study was conducted on 1017 CL patients that were referred to the urban and rural comprehensive health centers of Qom Province under the supervision of Qom University of Medical Sciences, Qom, Iran, from April 2014 to March 2019 through the census. The recovery time was measured by the Kaplan-Meier method, and then the survival function was plotted based on each variable. The Log-Rank test was applied to analyze the differences among variables, and after the evaluation of the PH assumption by Shoenfeld residuals, a stepwise forward Cox progressive regression was used to determine factors affecting intralesional or systematic treatment duration in the patients involved with cutaneous leishmaniasis. Results: The recovery rate of lesions in cutaneous leishmaniasis cases was found to be 96.7% by the intralesional treatment and 93% by the systematic one. The mean recovery time for cutaneous leishmaniasis patients was 8.00 weeks for the intralesional treatment and 18.00 days for the systematic treatment. The only significant variable in the intralesional treatment was observed on cases with thigh lesions, meaning that those patients who had CL lesions on their thighs experienced a significant reduction in their recovery time. Furthermore, the lesion variable was also significant (P=0.039) as the recovery chance of those patients who had four or more CL lesions was 30% less. Conclusion: The existence of lesions on CL patients’ thighs and a low number of lesions in CL patients can decrease the recovery time. The use of the Cox regression model in medical studies is more appropriate because not only does it consider the occurrence of the event but also it can reveal the occurrence time of the disease.
