Leishmanioses do continente americano

Conceição-Silva, Fátima; Alves, Carlos Roberto

doi:10.7476/9788575415689

Cited by 8 publications

(19 citation statements)

References 1,325 publications

(1,916 reference statements)

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“…When clinical differences such as comorbidity, immunosuppression and age are added to the balance, markedly different treatment strategies might be required [3, 10]. …”

Section: Discussionmentioning

confidence: 99%

“…The use of high dose of antimony for the treatment of ACL is supported by a large body of evidence [1, 3, 10, 12, 60] and should remain as the standard treatment. In patients older than 50 years of age or in a subgroup of patients where drug toxicity is an important consideration, low dose might be preferred.…”

Section: Discussionmentioning

confidence: 99%

“…High dose of pentavalent antimony represents the current standard treatment for cutaneous leishmaniasis [3, 10, 12]. Specifically, World Health Organization (WHO) recommends pentavalent antimony (Sb 5+ ) at a standard dose of 20 mg Sb 5+ /kg/day (high dose) administered by intramuscular or intravenous injection for 20 days with no ceiling dose [10].…”

Section: Introductionmentioning

confidence: 99%

“…Leishmaniasis is a complex of vector-borne diseases caused by more than 20 species of the protozoan genus Leishmania , which are transmitted by a variety of female sandfly species [ 1 – 3 ]. It is considered one of the most neglected diseases in the world given its direct link to poverty and the glaring imbalance between its enormous healthcare burden and the limited resources invested in research and new drug development [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

et al. 2017

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BackgroundAlthough high dose of antimony is the mainstay for treatment of American cutaneous leishmaniasis (ACL), ongoing major concerns remain over its toxicity. Whether or not low dose antimony regimens provide non-inferior effectiveness and lower toxicity has long been a question of dispute.MethodsA single-blind, non-inferiority, randomized controlled trial was conducted comparing high dose with low dose of antimony in subjects with ACL treated at a referral center in Rio de Janeiro, an endemic area of Leishmania (Viannia) braziliensis transmission. The primary outcome was clinical cure at 360 days of follow-up in the modified-intention-to-treat (mITT) and per-protocol (PP) populations. Non-inferiority margin was 15%. Secondary objectives included occurrence of epithelialization, adverse events and drug discontinuations. This study was registered in ClinicalTrials.gov: NCT01301924.ResultsOverall, 72 patients were randomly assigned to one of the two treatment arms during October 2008 to July 2014. In mITT, clinical cure was observed in 77.8% of subjects in the low dose antimony group and 94.4% in the high dose antimony group after one series of treatment (risk difference 16.7%; 90% CI, 3.7–29.7). The results were confirmed in PP analysis, with 77.8% of subjects with clinical cure in the low dose antimony group and 97.1% in the high dose antimony group (risk difference 19.4%; 90% CI, 7.1–31.7). The upper limit of the confidence interval exceeded the 15% threshold and was also above zero supporting the hypothesis that low dose is inferior to high dose of antimony after one series of treatment. Nevertheless, more major adverse events, a greater number of adverse events and major adverse events per subject, and more drug discontinuations were observed in the high dose antimony group (all p<0.05). Interestingly, of all the subjects who were originally allocated to the low dose antimony group and were followed up after clinical failure, 85.7% achieved cure after a further treatment with local therapy or low dose of antimony.ConclusionsCompared with high dose, low dose of antimony was inferior at the pre-specified margin after one series of treatment of ACL, but was associated with a significantly lower toxicity. While high dose of antimony should remain the standard treatment for ACL, low dose antimony treatment might be preferred when toxicity is a primary concern.

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“…When clinical differences such as comorbidity, immunosuppression and age are added to the balance, markedly different treatment strategies might be required [3, 10]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

et al. 2017

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“…2012 , MS/SVS 2017 ). It is believed that ML is a secondary form of ATL, caused by dissemination through the blood, and that it can occur several years after healing of the primary cutaneous lesion ( Conceição-Silva & Alves 2014 , MS/SVS 2017 ).…”

mentioning

confidence: 99%

Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

Brahim

Valete‐Rosalino

Antônio

et al. 2017

Mem. Inst. Oswaldo Cruz

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BACKGROUNDAmerican tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil.OBJECTIVESTo evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013.METHODSData were recovered from records of all ATL patients diagnosed during that period.FINDINGSOut of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up.MAIN CONCLUSIONSAlternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

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Identification of infection by Leishmania spp. in wild and domestic animals in Brazil: a systematic review with meta-analysis (2001–2021)

et al. 2023

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Leishmanioses do continente americano

Cited by 8 publications

References 1,325 publications

Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

Identification of infection by Leishmania spp. in wild and domestic animals in Brazil: a systematic review with meta-analysis (2001–2021)

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