PLoS Neglected Tropical Diseases (Sep 2021)

An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.

  • Carla Oliveira-Ribeiro,
  • Maria Inês Fernandes Pimentel,
  • Liliane de Fátima Antonio Oliveira,
  • Érica de Camargo Ferreira E Vasconcellos,
  • Fatima Conceição-Silva,
  • Armando de Oliveira Schubach,
  • Aline Fagundes,
  • Cintia Xavier de Mello,
  • Eliame Mouta-Confort,
  • Luciana de Freitas Campos Miranda,
  • Claudia Maria Valete-Rosalino,
  • Ana Cristina da Costa Martins,
  • Raquel de Vasconcellos Carvalhaes de Oliveira,
  • Leonardo Pereira Quintella,
  • Marcelo Rosandiski Lyra

DOI
https://doi.org/10.1371/journal.pntd.0009734
Journal volume & issue
Vol. 15, no. 9
p. e0009734

Abstract

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BackgroundTreatment of cutaneous leishmaniasis (CL) remains challenging since the drugs currently used are quite toxic, thus contributing to lethality unrelated to the disease itself but to adverse events (AE). The main objective was to evaluate different treatment regimens with meglumine antimoniate (MA), in a reference center in Rio de Janeiro, Brazil.MethodologyA historical cohort of 592 patients that underwent physical and laboratory examination were enrolled between 2000 and 2017. The outcome measures of effectiveness were epithelialization and complete healing of cutaneous lesions. AE were graded using a standardized scale. Three groups were evaluated: Standard regimen (SR): intramuscular (IM) MA 10-20 mg Sb5+/kg/day during 20 days (n = 46); Alternative regimen (AR): IM MA 5 mg Sb5+/kg/day during 30 days (n = 456); Intralesional route (IL): MA infiltration in the lesion(s) through subcutaneous injections (n = 90). Statistical analysis was performed through Fisher exact and Pearson Chi-square tests, Kruskal-Wallis, Kaplan-Meier and log-rank tests.ResultsSR, AR and IL showed efficacy of 95.3%, 84.3% and 75.9%, with abandonment rate of 6.5%, 2.4% and 3.4%, respectively. IL patients had more comorbidities (58.9%; p = 0.001), were mostly over 50 years of age (55.6%), and had an evolution time longer than 2 months (65.6%; p = 0.02). Time for epithelialization and complete healing were similar in IL and IM MA groups (p = 0.9 and p = 0.5; respectively). Total AE and moderate to severe AE that frequently led to treatment interruption were more common in SR group, while AR and IL showed less toxicity.Conclusions/significanceAR and IL showed less toxicity and may be good options especially in CL cases with comorbidities, although SR treatment was more effective. IL treatment was an effective and safe strategy, and it may be used as first therapy option as well as a rescue scheme in patients initially treated with other drugs.