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

<h4>Background</h4>Treatment 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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/9b4a641b8bb2434f993f136602e5c7ad
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spelling	oai:doaj.org-article:9b4a641b8bb2434f993f136602e5c7ad2021-12-02T20:24:03ZAn old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.1935-27271935-273510.1371/journal.pntd.0009734https://doaj.org/article/9b4a641b8bb2434f993f136602e5c7ad2021-09-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009734https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Treatment 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.<h4>Methodology</h4>A 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.<h4>Results</h4>SR, 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.<h4>Conclusions/significance</h4>AR 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.Carla Oliveira-RibeiroMaria Inês Fernandes PimentelLiliane de Fátima Antonio OliveiraÉrica de Camargo Ferreira E VasconcellosFatima Conceição-SilvaArmando de Oliveira SchubachAline FagundesCintia Xavier de MelloEliame Mouta-ConfortLuciana de Freitas Campos MirandaClaudia Maria Valete-RosalinoAna Cristina da Costa MartinsRaquel de Vasconcellos Carvalhaes de OliveiraLeonardo Pereira QuintellaMarcelo Rosandiski LyraPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 9, p e0009734 (2021)
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 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 An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.
description	<h4>Background</h4>Treatment 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.<h4>Methodology</h4>A 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.<h4>Results</h4>SR, 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.<h4>Conclusions/significance</h4>AR 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.
format	article
author	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
author_facet	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
author_sort	Carla Oliveira-Ribeiro
title	An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.
title_short	An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.
title_full	An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.
title_fullStr	An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.
title_full_unstemmed	An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.
title_sort	old drug and different ways to treat cutaneous leishmaniasis: intralesional and intramuscular meglumine antimoniate in a reference center, rio de janeiro, brazil.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/9b4a641b8bb2434f993f136602e5c7ad
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An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil.

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