Favorable responses to treatment with 5 mg Sbv/kg/day meglumine antimoniate in patients with American tegumentary leishmaniasis acquired in different Brazilian regions

Abstract

Introduction: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sb v /kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. Methods: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sb v /kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). Results: One course of 5 mg Sb v /kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. Conclusions: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.

Leishmaniose Tegumentar no Estado do Mato Grosso: Características Sociodemográficas e de Saúde Associados com Reações Adversas Laboratoriais e Eletrocardiográficas

“…Ensaios, v. 24, n. 3, p. 234-241, 2020 cutaneous and mucosal leishmaniasis, respectively. Although antimonials display important limitations such as high cost (EID RODRÍGUEZ et al, 2019), toxicity and long periods of treatment, the pentavalent antimonial has a clinical cure rate of up to 80% when used in tegumentary leishmaniasis treatment (CATALDO et al, 2018;WHO;PAHO, 2019), similar cure rate was observed in the present study.…”

“…The pentavalent antimonial has a clinical cure rate of up to 80% when used in tegumentary leishmaniasis treatment (SAHEKI et al, 2017;CATALDO et al, 2018), however this drug display important limitations such as parenteral administration, high toxicity, high cost and long periods of treatment (MARQUES et al, 2019). Antimony therapy is often accompanied by severe side effects that include cardiotoxicity, pancreatitis and hepatotoxicity (SADEGHIAN;ZIAEI;SADEGHI, 2008;LYRA et al, 2016).…”

Serine Proteases Profiles of Leishmania (Viannia) Braziliensis Clinical Isolates With Distinct Susceptibilities to Antimony

“…Moreover, serine proteases activity and differential transcripts expression suggested that each isolate may have independent means to adapt to their niches and that in vitro response to antimony needs further characterization, especially in clinical isolates causing ATL. Laboratory (LaPClinVigiLeish) at INI -Fiocruz were responsible for this classi cation following the criteria reported for ATL patient's treatment in the state of Rio de Janeiro -Brazil (4,5,54). All the isolates included in this study were previously characterized as L. (V.) braziliensis by multilocus enzyme electrophoresis (MLEE), according to procedures described elsewhere (55).…”

“…A pentavalent antimony formulation -Glucantime® (Sb V ) -is the rst-line treatment against ATL and has not changed in the last 70 years (1). In South America, this treatment doses (low and high dose) vary according to therapeutic response patterns seen in speci c geographical areas (3)(4)(5). Its mechanism of action is still not completely understood, but, it has been well accepted the hypothesis that Sb V needs to be reduced to its trivalent form (Sb III ), either directly by the parasite or within the host macrophages, to excel leishmanicidal activity (6)(7)(8).…”

Geospatial analysis of tegumentary leishmaniasis in Rio de Janeiro state, Brazil from 2000 to 2015: Species typing and flow of travelers and migrants with leishmaniasis

“…(V . ) guyanensis infections are common, which has poor response to antimonials and should be initially treated with pentamidine [51,52].…”