Effectiveness of miltefosine in cutaneous leishmaniasis caused by Leishmania tropica in Pakistan after antimonial treatment failure or contraindications to first line therapy-A retrospective analysis.
den Boer, M
MetadataShow full item record
JournalPLOS Neglected Tropical Diseases
AbstractBackground: Cutaneous leishmaniasis (CL) is a neglected tropical skin disease, caused by Leishmania protozoa. In Pakistan, where CL caused by L. tropica is highly endemic, therapy with pentavalent antimonials is the standard of care, but has significant toxicity when used in systemic therapy, while are no evidence-based safer alternative treatment options for L. tropica. The efficacy of oral miltefosine has not been studied in CL caused by L. tropica. We evaluated effectiveness and tolerability of miltefosine in patients with previous treatment failure or with contraindications to systemic antimonial treatment. Methods: A retrospective review was conducted of a cohort of CL patients who were treated with a 28-day course of miltefosine between December 2017 and August 2019, in urban Quetta, Pakistan, an area endemic for L. tropica. Descriptive analyses were performed, and effectiveness was assessed by initial response after treatment, and final cure at routine follow up visits, six weeks to three months post-treatment. Tolerability was assessed by routinely reported adverse events. Results: Of the 76 CL patients in the cohort, 42 (55%) had contraindications to systemic antimonial treatment, and 34 (45%) had failure or relapse after antimonial treatment. Twelve patients defaulted during treatment and 12 patients were lost to follow up. In the remaining 52 patients, final cure rate was 77% (40/52). In those with contraindications to systemic antimonial treatment the final cure rate was 83% (24/29) and in the failure and relapse group 70% (16/23). Twenty-eight patients (40.0%) reported 39 mild to moderate adverse events with the main complaints being nausea (41.0%), general malaise (25.6%), and stomach pain (12.8%). Conclusion: Results indicate that miltefosine is an effective second line treatment in CL in areas endemic for L. tropica. Prospective studies with systematic follow up are needed to obtain definitive evidence of effectiveness and tolerability, including identification of risk factors for miltefosine treatment failure.
PublisherPublic Library of Science
- Interventions for American cutaneous and mucocutaneous leishmaniasis.
- Authors: Pinart M, Rueda JR, Romero GA, Pinzón-Flórez CE, Osorio-Arango K, Silveira Maia-Elkhoury AN, Reveiz L, Elias VM, Tweed JA
- Issue date: 2020 Aug 27
- Efficacy and Tolerability of Miltefosine in the Treatment of Cutaneous Leishmaniasis.
- Authors: Ware JM, O'Connell EM, Brown T, Wetzler L, Talaat KR, Nutman TB, Nash TE
- Issue date: 2020 Oct 28
- Failure of an Innovative Low-Cost, Noninvasive Thermotherapy Device for Treating Cutaneous Leishmaniasis Caused by <i>Leishmania tropica</i> in Pakistan.
- Authors: Kämink S, Abdi A, Kamau C, Ashraf S, Ansari MA, Qureshi NA, Schallig H, Grobusch MP, Fernhout J, Ritmeijer K
- Issue date: 2019 Dec
- Old world cutaneous leishmaniasis in Iran: clinical variants and treatments.
- Authors: Firooz A, Mortazavi H, Khamesipour A, Ghiasi M, Abedini R, Balighi K, Esmaili N, Nassiri-Kashani M, Eskandari SE, Mohebali M, Mir Amin Mohammadi A, Dowlati Y
- Issue date: 2020 Jan 8
- Interventions for Old World cutaneous leishmaniasis.
- Authors: Heras-Mosteiro J, Monge-Maillo B, Pinart M, Lopez Pereira P, Reveiz L, Garcia-Carrasco E, Campuzano Cuadrado P, Royuela A, Mendez Roman I, López-Vélez R
- Issue date: 2017 Dec 1