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Comparative study on liposomal amphotericin B and other therapies in the treatment of mucosal leishmaniasis: A 15-year retrospective cohort study.
PLoS One. 2019; 14(6):e0218786.Plos

Abstract

BACKGROUND

Liposomal amphotericin B (L-AMB) has been used for mucosal leishmaniasis (ML), but comparative studies on L-AMB and other drugs used for the treatment of ML have not been conducted. The present study aimed to evaluate the outcome of patients with ML who were treated with L-AMB.

METHODS

This is a 15-year retrospective study of Brazilian patients with a confirmed diagnosis of ML. The therapeutic options for the treatment of ML consisted of L-AMB, amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (d-AMB), itraconazole, antimonial pentavalent, or pentamidine. Healing, cure rate and adverse effects (AEs) associated with the drugs used to treat this condition were analyzed.

RESULTS

In 71 patients, a total of 105 treatments were evaluated. The outcome of the treatment with each drug was compared, and results showed that L-AMB was superior to other therapeutic regimens (P = 0.001; odds ratio [OR] = 4.84; 95% confidence interval [CI] = 1.78-13.17). d-AMB had worse AEs than other treatment regimens (P = 0.001, OR = 0.09; 95% CI = 0.09-0.43). Approximately 66% of the patients presented with AEs during ML treatment. Although L-AMB was less nephrotoxic than d-AMB, it was associated with acute kidney injury compared with other drugs (P <0.05).

CONCLUSION

L-AMB was more effective than other therapies for the treatment of ML. However, a high incidence of toxicity was associated with its use. Therapeutic choices should be reassessed, and the development of new drugs is necessary for the treatment of ML.

Authors+Show Affiliations

Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brasil.School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brasil.School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brasil.Laboratório de Parasitologia LIM-46, Instituto de Medicina Tropical, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brasil.Departamento de Otorrinolaringologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil.Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brasil.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

31242231

Citation

Santos, Carolina Rocio, et al. "Comparative Study On Liposomal Amphotericin B and Other Therapies in the Treatment of Mucosal Leishmaniasis: a 15-year Retrospective Cohort Study." PloS One, vol. 14, no. 6, 2019, pp. e0218786.
Santos CR, Tuon FF, Cieslinski J, et al. Comparative study on liposomal amphotericin B and other therapies in the treatment of mucosal leishmaniasis: A 15-year retrospective cohort study. PLoS One. 2019;14(6):e0218786.
Santos, C. R., Tuon, F. F., Cieslinski, J., de Souza, R. M., Imamura, R., & Amato, V. S. (2019). Comparative study on liposomal amphotericin B and other therapies in the treatment of mucosal leishmaniasis: A 15-year retrospective cohort study. PloS One, 14(6), e0218786. https://doi.org/10.1371/journal.pone.0218786
Santos CR, et al. Comparative Study On Liposomal Amphotericin B and Other Therapies in the Treatment of Mucosal Leishmaniasis: a 15-year Retrospective Cohort Study. PLoS One. 2019;14(6):e0218786. PubMed PMID: 31242231.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative study on liposomal amphotericin B and other therapies in the treatment of mucosal leishmaniasis: A 15-year retrospective cohort study. AU - Santos,Carolina Rocio, AU - Tuon,Felipe Francisco, AU - Cieslinski,Juliette, AU - de Souza,Regina Maia, AU - Imamura,Rui, AU - Amato,Valdir Sabbaga, Y1 - 2019/06/26/ PY - 2019/03/09/received PY - 2019/06/11/accepted PY - 2019/6/27/entrez PY - 2019/6/27/pubmed PY - 2020/2/25/medline SP - e0218786 EP - e0218786 JF - PloS one JO - PLoS One VL - 14 IS - 6 N2 - BACKGROUND: Liposomal amphotericin B (L-AMB) has been used for mucosal leishmaniasis (ML), but comparative studies on L-AMB and other drugs used for the treatment of ML have not been conducted. The present study aimed to evaluate the outcome of patients with ML who were treated with L-AMB. METHODS: This is a 15-year retrospective study of Brazilian patients with a confirmed diagnosis of ML. The therapeutic options for the treatment of ML consisted of L-AMB, amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (d-AMB), itraconazole, antimonial pentavalent, or pentamidine. Healing, cure rate and adverse effects (AEs) associated with the drugs used to treat this condition were analyzed. RESULTS: In 71 patients, a total of 105 treatments were evaluated. The outcome of the treatment with each drug was compared, and results showed that L-AMB was superior to other therapeutic regimens (P = 0.001; odds ratio [OR] = 4.84; 95% confidence interval [CI] = 1.78-13.17). d-AMB had worse AEs than other treatment regimens (P = 0.001, OR = 0.09; 95% CI = 0.09-0.43). Approximately 66% of the patients presented with AEs during ML treatment. Although L-AMB was less nephrotoxic than d-AMB, it was associated with acute kidney injury compared with other drugs (P <0.05). CONCLUSION: L-AMB was more effective than other therapies for the treatment of ML. However, a high incidence of toxicity was associated with its use. Therapeutic choices should be reassessed, and the development of new drugs is necessary for the treatment of ML. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31242231/Comparative_study_on_liposomal_amphotericin_B_and_other_therapies_in_the_treatment_of_mucosal_leishmaniasis:_A_15_year_retrospective_cohort_study_ L2 - https://dx.plos.org/10.1371/journal.pone.0218786 DB - PRIME DP - Unbound Medicine ER -