Effectiveness and Safety of Amphotericin B Deoxycholate, Amphotericin B Colloidal Dispersion, and Liposomal Amphotericin B as Third-Line Treatments for Cutaneous and Mucocutaneous Leishmaniasis: A Retrospective Study

Abstract

Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) are endemic diseases in America, especially in some countries such as Colombia. Among the therapeutic options is amphotericin B (AB). Nevertheless, its lipid-associated formulations have better safety profiles and effectiveness in other diseases, so far with no comparative studies in CL or MCL. We conducted a retrospective descriptive study describing the effectiveness and adverse effects of AB deoxycholate (ABD), AB colloidal dispersion (ABCD), and liposomal AB (LAB) as third-line treatments for CL and MCL. The effectiveness of LAB (88.5%) was greater than those of ABCD (66.6%) and ABD (80.8%). There were also fewer adverse effects in the LAB group (46.2%) than in the ABD (96.1%) and ABCD (80.9%) groups. LAB is an alternative for the treatment of CL and MCL in patients with therapeutic failure to firstand second-line drugs; findings suggest it might be less toxic and more effective than ABD and ABCD.

Cutaneous leishmaniasis in travellers and migrants: a 10-year case series in a Canadian reference centre for tropical diseases

“…The treatment response rate is variable, in the range of 72%-88% in some studies of Old World and New World species; more recent studies have described response rates as low as 46% when looking at clinical cure at 90 days and 63% when delayed healing and a second course of liposomal amphotericin B were included. [23][24][25][26][27][28][29] In our study, 30% of patients who received liposomal amphotericin B had adverse events, with acute kidney injury being the most common (50%). Rates of adverse events with liposomal amphotericin B in the treatment of cutaneous leishmaniasis have been reported to be as high as 46%-53%.…”

“…Rates of adverse events with liposomal amphotericin B in the treatment of cutaneous leishmaniasis have been reported to be as high as 46%-53%. 26,28…”

Treatment of pediatric cutaneous leishmaniasis with liposomal amphotericin B

“…Amphotericin B triggers the release of inflammatory molecules such as interleukin 1B, leading to fever, arthralgia, headache, and infusion‐related gastrointestinal symptoms 18–20 . In addition, vasoconstriction of the afferent arteriole and its uptake by renal tubular cells trigger hypokalemia, hypomagnesemia, renal tubular acidosis, polyuria, and hyperazotemia 18–23 …”

Tegumentary leishmaniasis by Leishmania braziliensis complex in Cochabamba, Bolivia including the presence of L. braziliensis outlier

“…Amphotericin B is not usually recommended due to its toxicity (renal, hepatic, etc. ), and is only used as an alternative in cases of treatment failure with first‐line drugs or in special situations (Organización Panamericana de la Salud, 2013; Rodríguez Galvis et al., 2020). Treatment failure is known to be more likely in mucosal lesions (Ministerio de Salud de Bolivia, 2015), possibly because this clinical manifestation is related to the immunocompromised status of the patient (perhaps due to difficulty in feeding), a factor that could contribute to the severity of the infection as well as the treatment failure of amphotericin B (Nweze et al., 2020; Van Griensven et al., 2014).…”