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Relationship between treatment regimens for visceral leishmaniasis and development of post-kala-azar dermal leishmaniasis and visceral leishmaniasis relapse: A cohort study from Bangladesh.
PLoS Negl Trop Dis. 2019 08; 13(8):e0007653.PN

Abstract

BACKGROUND

We investigated the relationship of treatment regimens for visceral leishmaniasis (VL) with post-kala-azar dermal leishmaniasis (PKDL) and visceral leishmaniasis relapse (VLR) development.

METHODS

Study subjects included cohorts of patients cured of VL since treatment with monotherapy by sodium stibogluconate (SSG), miltefosine (MF), paromomycin intramuscular injection (PMIM), liposomal amphotericin B [AmBisome (AMB)] in a single dose (SDAMB) and in multidose (MDAMB), and combination therapies by AMB+PMIM, AMB+MF, and PMIM+MF. Follow up period was 4 years after treatment. Cohorts were prospective except SSG (retrospective) and MF (partially retrospective). We compared incidence proportion and rate in 100-person-4year of PKDL and VLR by treatment regimens using univariate and multivariate analysis.

FINDINGS

974 of 984 enrolled participants completed the study. Overall incidence proportion for PKDL and VLR was 12.3% (95% CI, 10.4%-14.5%) and 7.0% (95% CI, 5.6%-8.8%) respectively. The incidence rate (95% CI) of PKDL and VLR was 14.0 (8.6-22.7) and 7.6 (4.1-14.7) accordingly. SSG cohort had the lowest incidence rate of PKDL at 3.0 (1.3-7.3) and VLR at 1.8 (0.6-5.6), followed by MDAMB at 8.2 (4.3-15.7) for PKDL and at 2.7 (0.9-8.4) for VLR.

INTERPRETATION

Development of PKDL and VLR is related with treatment regimens for VL. SSG and MDAMB resulted in less incidence of PKDL and VLR compared to other treatment regimens. MDAMB should be considered for VL as a first step for prevention of PKDL and VLR since SSG is highly toxic and not recommended for VL.

Authors+Show Affiliations

Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.PATH, Dr. Gopal Das Bhawan, New Delhi, India.PATH, Dr. Gopal Das Bhawan, New Delhi, India.Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.Department of Medicine, Shaheed Suhrawardy Medical College, Sher-E-Bangla Nagar, Dhaka, Bangladesh & Universal Medical College Research Centre, Mohakhali, Dhaka, Bangldesh.Drugs for Neglected Diseases initiative, Chemin Louis-Dunant, Geneva, Switzerland.Disease Control Unit, Directorate General of Health Services, Ministry of Health and Family Welfare of Bangladesh, Mohakhali, Dhaka, Bangladesh.Infectious Disease Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.

Pub Type(s)

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

Language

eng

PubMed ID

31415565

Citation

Mondal, Dinesh, et al. "Relationship Between Treatment Regimens for Visceral Leishmaniasis and Development of Post-kala-azar Dermal Leishmaniasis and Visceral Leishmaniasis Relapse: a Cohort Study From Bangladesh." PLoS Neglected Tropical Diseases, vol. 13, no. 8, 2019, pp. e0007653.
Mondal D, Kumar A, Sharma A, et al. Relationship between treatment regimens for visceral leishmaniasis and development of post-kala-azar dermal leishmaniasis and visceral leishmaniasis relapse: A cohort study from Bangladesh. PLoS Negl Trop Dis. 2019;13(8):e0007653.
Mondal, D., Kumar, A., Sharma, A., Ahmed, M. M., Hasnain, M. G., Alim, A., Huda, M. M., Rahman, R., Alvar, J., Ahmed, B. N., & Haque, R. (2019). Relationship between treatment regimens for visceral leishmaniasis and development of post-kala-azar dermal leishmaniasis and visceral leishmaniasis relapse: A cohort study from Bangladesh. PLoS Neglected Tropical Diseases, 13(8), e0007653. https://doi.org/10.1371/journal.pntd.0007653
Mondal D, et al. Relationship Between Treatment Regimens for Visceral Leishmaniasis and Development of Post-kala-azar Dermal Leishmaniasis and Visceral Leishmaniasis Relapse: a Cohort Study From Bangladesh. PLoS Negl Trop Dis. 2019;13(8):e0007653. PubMed PMID: 31415565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between treatment regimens for visceral leishmaniasis and development of post-kala-azar dermal leishmaniasis and visceral leishmaniasis relapse: A cohort study from Bangladesh. AU - Mondal,Dinesh, AU - Kumar,Amresh, AU - Sharma,Abhijit, AU - Ahmed,Moshtaq Mural, AU - Hasnain,Md Golam, AU - Alim,Abdul, AU - Huda,M Mamun, AU - Rahman,Ridwanur, AU - Alvar,Jorge, AU - Ahmed,Be-Nazir, AU - Haque,Rashidul, Y1 - 2019/08/15/ PY - 2019/04/17/received PY - 2019/07/23/accepted PY - 2019/08/27/revised PY - 2019/8/16/pubmed PY - 2020/1/8/medline PY - 2019/8/16/entrez SP - e0007653 EP - e0007653 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 13 IS - 8 N2 - BACKGROUND: We investigated the relationship of treatment regimens for visceral leishmaniasis (VL) with post-kala-azar dermal leishmaniasis (PKDL) and visceral leishmaniasis relapse (VLR) development. METHODS: Study subjects included cohorts of patients cured of VL since treatment with monotherapy by sodium stibogluconate (SSG), miltefosine (MF), paromomycin intramuscular injection (PMIM), liposomal amphotericin B [AmBisome (AMB)] in a single dose (SDAMB) and in multidose (MDAMB), and combination therapies by AMB+PMIM, AMB+MF, and PMIM+MF. Follow up period was 4 years after treatment. Cohorts were prospective except SSG (retrospective) and MF (partially retrospective). We compared incidence proportion and rate in 100-person-4year of PKDL and VLR by treatment regimens using univariate and multivariate analysis. FINDINGS: 974 of 984 enrolled participants completed the study. Overall incidence proportion for PKDL and VLR was 12.3% (95% CI, 10.4%-14.5%) and 7.0% (95% CI, 5.6%-8.8%) respectively. The incidence rate (95% CI) of PKDL and VLR was 14.0 (8.6-22.7) and 7.6 (4.1-14.7) accordingly. SSG cohort had the lowest incidence rate of PKDL at 3.0 (1.3-7.3) and VLR at 1.8 (0.6-5.6), followed by MDAMB at 8.2 (4.3-15.7) for PKDL and at 2.7 (0.9-8.4) for VLR. INTERPRETATION: Development of PKDL and VLR is related with treatment regimens for VL. SSG and MDAMB resulted in less incidence of PKDL and VLR compared to other treatment regimens. MDAMB should be considered for VL as a first step for prevention of PKDL and VLR since SSG is highly toxic and not recommended for VL. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/31415565/Relationship_between_treatment_regimens_for_visceral_leishmaniasis_and_development_of_post_kala_azar_dermal_leishmaniasis_and_visceral_leishmaniasis_relapse:_A_cohort_study_from_Bangladesh_ L2 - https://dx.plos.org/10.1371/journal.pntd.0007653 DB - PRIME DP - Unbound Medicine ER -