First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.

<h4>Background</h4>Current therapies for cutaneous leishmaniasis are limited by poor efficacy, long-term course of treatment, and the development of resistance. We evaluated if pentavalent antimony (an anti-parasitic drug) combined with imiquimod (an immunomodulator) was more effective t...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Cesar Miranda-Verastegui, Gianfranco Tulliano, Theresa W Gyorkos, Wessmark Calderon, Elham Rahme, Brian Ward, Maria Cruz, Alejandro Llanos-Cuentas, Greg Matlashewski
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2009
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/506f33e49e7548ba8ca415edae800b2e
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:506f33e49e7548ba8ca415edae800b2e
record_format	dspace
spelling	oai:doaj.org-article:506f33e49e7548ba8ca415edae800b2e2021-11-25T06:33:15ZFirst-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.1935-27271935-273510.1371/journal.pntd.0000491https://doaj.org/article/506f33e49e7548ba8ca415edae800b2e2009-07-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19636365/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Current therapies for cutaneous leishmaniasis are limited by poor efficacy, long-term course of treatment, and the development of resistance. We evaluated if pentavalent antimony (an anti-parasitic drug) combined with imiquimod (an immunomodulator) was more effective than pentavalent antimony alone in patients who had not previously been treated.<h4>Methods</h4>A randomized double-blind clinical trial involving 80 cutaneous leishmaniasis patients was conducted in Peru. The study subjects were recruited in Lima and Cusco (20 experimental and 20 control subjects at each site). Experimental arm: Standard dose of pentavalent antimony plus 5% imiquimod cream applied to each lesion three times per week for 20 days. Control arm: Standard dose of pentavalent antimony plus placebo (vehicle cream) applied as above. The primary outcome was cure defined as complete re-epithelization with no inflammation assessed during the 12 months post-treatment period.<h4>Results</h4>Of the 80 subjects enrolled, 75 completed the study. The overall cure rate at the 12-month follow-up for the intention-to-treat analysis was 75% (30/40) in the experimental arm and 58% (23/40) in the control arm (p = 0.098). Subgroup analyses suggested that combination treatment benefits were most often observed at the Cusco site, where L. braziliensis is the prevalent species. Over the study period, only one adverse event (rash) was recorded, in the experimental arm.<h4>Conclusion</h4>The combination treatment of imiquimod plus pentavalent antimony performed better than placebo plus pentavalent antimony, but the difference was not statistically significant.<h4>Trial registration</h4>Clinical Trials.gov NCT00257530.Cesar Miranda-VerasteguiGianfranco TullianoTheresa W GyorkosWessmark CalderonElham RahmeBrian WardMaria CruzAlejandro Llanos-CuentasGreg MatlashewskiPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 3, Iss 7, p e491 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Cesar Miranda-Verastegui Gianfranco Tulliano Theresa W Gyorkos Wessmark Calderon Elham Rahme Brian Ward Maria Cruz Alejandro Llanos-Cuentas Greg Matlashewski First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.
description	<h4>Background</h4>Current therapies for cutaneous leishmaniasis are limited by poor efficacy, long-term course of treatment, and the development of resistance. We evaluated if pentavalent antimony (an anti-parasitic drug) combined with imiquimod (an immunomodulator) was more effective than pentavalent antimony alone in patients who had not previously been treated.<h4>Methods</h4>A randomized double-blind clinical trial involving 80 cutaneous leishmaniasis patients was conducted in Peru. The study subjects were recruited in Lima and Cusco (20 experimental and 20 control subjects at each site). Experimental arm: Standard dose of pentavalent antimony plus 5% imiquimod cream applied to each lesion three times per week for 20 days. Control arm: Standard dose of pentavalent antimony plus placebo (vehicle cream) applied as above. The primary outcome was cure defined as complete re-epithelization with no inflammation assessed during the 12 months post-treatment period.<h4>Results</h4>Of the 80 subjects enrolled, 75 completed the study. The overall cure rate at the 12-month follow-up for the intention-to-treat analysis was 75% (30/40) in the experimental arm and 58% (23/40) in the control arm (p = 0.098). Subgroup analyses suggested that combination treatment benefits were most often observed at the Cusco site, where L. braziliensis is the prevalent species. Over the study period, only one adverse event (rash) was recorded, in the experimental arm.<h4>Conclusion</h4>The combination treatment of imiquimod plus pentavalent antimony performed better than placebo plus pentavalent antimony, but the difference was not statistically significant.<h4>Trial registration</h4>Clinical Trials.gov NCT00257530.
format	article
author	Cesar Miranda-Verastegui Gianfranco Tulliano Theresa W Gyorkos Wessmark Calderon Elham Rahme Brian Ward Maria Cruz Alejandro Llanos-Cuentas Greg Matlashewski
author_facet	Cesar Miranda-Verastegui Gianfranco Tulliano Theresa W Gyorkos Wessmark Calderon Elham Rahme Brian Ward Maria Cruz Alejandro Llanos-Cuentas Greg Matlashewski
author_sort	Cesar Miranda-Verastegui
title	First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.
title_short	First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.
title_full	First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.
title_fullStr	First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.
title_full_unstemmed	First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.
title_sort	first-line therapy for human cutaneous leishmaniasis in peru using the tlr7 agonist imiquimod in combination with pentavalent antimony.
publisher	Public Library of Science (PLoS)
publishDate	2009
url	https://doaj.org/article/506f33e49e7548ba8ca415edae800b2e
work_keys_str_mv	AT cesarmirandaverastegui firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT gianfrancotulliano firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT theresawgyorkos firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT wessmarkcalderon firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT elhamrahme firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT brianward firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT mariacruz firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT alejandrollanoscuentas firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony AT gregmatlashewski firstlinetherapyforhumancutaneousleishmaniasisinperuusingthetlr7agonistimiquimodincombinationwithpentavalentantimony
_version_	1718413679856189440

First-line therapy for human cutaneous leishmaniasis in Peru using the TLR7 agonist imiquimod in combination with pentavalent antimony.

Ejemplares similares