Interventions for American cutaneous and mucocutaneous leishmaniasis

Area of Science:

• Infectious Diseases
• Parasitology
• Dermatology

Background:

• American cutaneous and mucocutaneous leishmaniasis (ACML) are caused by Leishmania parasites.
• Pentavalent antimonials are the primary treatment, but alternative interventions require effectiveness and safety reviews.
• This study updates a 2009 Cochrane Review on ACML interventions.

Purpose of the Study:

• To assess the effectiveness and safety of interventions for ACML in immunocompetent individuals.
• To evaluate treatments for American cutaneous and mucocutaneous leishmaniasis.

Main Methods:

• Updated systematic search of multiple databases and trials registers up to August 2019.
• Included 75 randomized controlled trials (RCTs) involving 6533 participants with ACML.
• Assessed cure rates, adverse effects, and recurrence using GRADE to determine evidence certainty.

Main Results:

• Intramuscular meglumine antimoniate (IMMA) may increase cure rates but likely increases severe adverse effects like myalgias and arthralgias.
• Oral miltefosine probably improves cure rates but significantly increases nausea and vomiting compared to placebo.
• Compared to IMMA, oral miltefosine showed similar cure rates but higher rates of nausea and vomiting; azithromycin likely reduced cure rates.

Conclusions:

• Evidence certainty for most comparisons was moderate or low, limiting conclusive findings.
• Both IMMA and oral miltefosine likely improve cure rates, with miltefosine causing more gastrointestinal side effects.
• Future research should focus on mucosal leishmaniasis treatments and evaluate ACML recurrence and progression.