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Study on the safety and efficacy of miltefosine for the treatment of children and adolescents with post-kala-azar dermal leishmaniasis in Bangladesh, and an association of serum vitamin E and exposure to arsenic with post-kala-azar dermal leishmaniasis: an open clinical trial and case-control study protocol.
BMJ Open. 2016 05 17; 6(5):e010050.BO

Abstract

INTRODUCTION

Post-kala-azar dermal leishmaniasis (PKDL) is a dermatological complication that occurs primarily among treated visceral leishmaniasis (VL) patients, and sporadically in a few without a history of VL. It mostly affects children and adolescents but is also common in adults. The conventional treatment with 120 intramuscular injections of sodium stibogluconate (SSG) is phasing out. Miltefosine (MF) is the only eventual alternative to SSG; however, its efficacy and safety profiles for treatment of children and adolescents with PKDL are lacking. In addition, risk factors for PKDL are poorly investigated. Host genetic, nutritional and environmental factors could be potential risk factors. As such, here we propose to evaluate the efficacy and safety of MF for 12 weeks at an allometric dose for children and adolescents with PKDL, and also to explore potential risk factors for PKDL.

METHODS AND ANALYSIS

A cross-sectional survey will look for suspected participants with PKDL among treated VL children and adolescents, a subsequent open clinical trial with MF at allometric dose, with a follow-up at 12 months. A case-control study will be carried out for PKDL risk factors. Assuming 95% cure rate, 95% CI and α=0.05, a sample size of 73 children with PKDL is needed. Considering an attrition rate of 10%, the final sample size is 80 children in each group. Descriptive and analytical analyses will be performed. Primary outcome is safety and cure rate of 12 weeks of treatment with MF.

ETHICS AND DISSEMINATION

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) Ethical Review Committee (ERC) approved the protocol (PR#013045). Written informed consent will be taken from all participants and their guardians (in case of minor). A Data and Safety Monitoring Board (DSMB) of ICDDR,B ERC will monitor all study activities to ensure the safety of the participants.

TRIAL REGISTRATION NUMBER

NCT02193022; Pre-results.

Authors+Show Affiliations

Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada.Department of Parasitology, Nagasaki University, Nagasaki, Japan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27188804

Citation

Mondal, D, et al. "Study On the Safety and Efficacy of Miltefosine for the Treatment of Children and Adolescents With Post-kala-azar Dermal Leishmaniasis in Bangladesh, and an Association of Serum Vitamin E and Exposure to Arsenic With Post-kala-azar Dermal Leishmaniasis: an Open Clinical Trial and Case-control Study Protocol." BMJ Open, vol. 6, no. 5, 2016, pp. e010050.
Mondal D, Hasnain MG, Hossain MS, et al. Study on the safety and efficacy of miltefosine for the treatment of children and adolescents with post-kala-azar dermal leishmaniasis in Bangladesh, and an association of serum vitamin E and exposure to arsenic with post-kala-azar dermal leishmaniasis: an open clinical trial and case-control study protocol. BMJ Open. 2016;6(5):e010050.
Mondal, D., Hasnain, M. G., Hossain, M. S., Ghosh, D., Ghosh, P., Hossain, H., Baker, J., Nath, R., Haque, R., Matlashewski, G., & Hamano, S. (2016). Study on the safety and efficacy of miltefosine for the treatment of children and adolescents with post-kala-azar dermal leishmaniasis in Bangladesh, and an association of serum vitamin E and exposure to arsenic with post-kala-azar dermal leishmaniasis: an open clinical trial and case-control study protocol. BMJ Open, 6(5), e010050. https://doi.org/10.1136/bmjopen-2015-010050
Mondal D, et al. Study On the Safety and Efficacy of Miltefosine for the Treatment of Children and Adolescents With Post-kala-azar Dermal Leishmaniasis in Bangladesh, and an Association of Serum Vitamin E and Exposure to Arsenic With Post-kala-azar Dermal Leishmaniasis: an Open Clinical Trial and Case-control Study Protocol. BMJ Open. 2016 05 17;6(5):e010050. PubMed PMID: 27188804.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Study on the safety and efficacy of miltefosine for the treatment of children and adolescents with post-kala-azar dermal leishmaniasis in Bangladesh, and an association of serum vitamin E and exposure to arsenic with post-kala-azar dermal leishmaniasis: an open clinical trial and case-control study protocol. AU - Mondal,D, AU - Hasnain,M G, AU - Hossain,M S, AU - Ghosh,D, AU - Ghosh,P, AU - Hossain,H, AU - Baker,J, AU - Nath,R, AU - Haque,R, AU - Matlashewski,G, AU - Hamano,S, Y1 - 2016/05/17/ PY - 2016/5/19/entrez PY - 2016/5/18/pubmed PY - 2018/1/2/medline SP - e010050 EP - e010050 JF - BMJ open JO - BMJ Open VL - 6 IS - 5 N2 - INTRODUCTION: Post-kala-azar dermal leishmaniasis (PKDL) is a dermatological complication that occurs primarily among treated visceral leishmaniasis (VL) patients, and sporadically in a few without a history of VL. It mostly affects children and adolescents but is also common in adults. The conventional treatment with 120 intramuscular injections of sodium stibogluconate (SSG) is phasing out. Miltefosine (MF) is the only eventual alternative to SSG; however, its efficacy and safety profiles for treatment of children and adolescents with PKDL are lacking. In addition, risk factors for PKDL are poorly investigated. Host genetic, nutritional and environmental factors could be potential risk factors. As such, here we propose to evaluate the efficacy and safety of MF for 12 weeks at an allometric dose for children and adolescents with PKDL, and also to explore potential risk factors for PKDL. METHODS AND ANALYSIS: A cross-sectional survey will look for suspected participants with PKDL among treated VL children and adolescents, a subsequent open clinical trial with MF at allometric dose, with a follow-up at 12 months. A case-control study will be carried out for PKDL risk factors. Assuming 95% cure rate, 95% CI and α=0.05, a sample size of 73 children with PKDL is needed. Considering an attrition rate of 10%, the final sample size is 80 children in each group. Descriptive and analytical analyses will be performed. Primary outcome is safety and cure rate of 12 weeks of treatment with MF. ETHICS AND DISSEMINATION: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) Ethical Review Committee (ERC) approved the protocol (PR#013045). Written informed consent will be taken from all participants and their guardians (in case of minor). A Data and Safety Monitoring Board (DSMB) of ICDDR,B ERC will monitor all study activities to ensure the safety of the participants. TRIAL REGISTRATION NUMBER: NCT02193022; Pre-results. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/27188804/Study_on_the_safety_and_efficacy_of_miltefosine_for_the_treatment_of_children_and_adolescents_with_post_kala_azar_dermal_leishmaniasis_in_Bangladesh_and_an_association_of_serum_vitamin_E_and_exposure_to_arsenic_with_post_kala_azar_dermal_leishmaniasis:_an_open_clinical_trial_and_case_control_study_protocol_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=27188804 DB - PRIME DP - Unbound Medicine ER -