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Comparative assessment of interventions for treating cutaneous leishmaniasis: A network meta-analysis of randomized
Kannan Sridharan1, Gowri Sivaramakrishnan2
1Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Introduction:
Various interventions including laser therapy, heat therapy, and several drugs have been trialed in patients with cutaneous leishmaniasis. Due to the lack of an evidence-based comparison of all these interventions, we carried out the present network meta-analysis.
Methods:
Electronic databases were searched for randomized clinical trials evaluating the efficacy and safety of any interventions in patients with cutaneous leishmaniasis. The proportion of patients with complete cure was the primary outcome. The proportion of lesions cured at the end of treatment, the proportion of lesions with minimal/no response to treatment, and proportion of wounds with minimal/no change were the secondary outcomes. Random-effects modeling was used for generating pooled estimates. Rankogram plot was used for identifying the 'best intervention'. For interventions containing a combination of treatments, backslash (/) has been used for depicting the same.
Results:
One-hundred and thirty-one studies were included. Intralesional meglumine, topical paromomycin/gentamicin, topical paromomycin, parenteral sodium stibogluconate, topical honey/intralesional meglumine, topical liposomal amphotericin B, oral zinc sulphate, oral miltefosine, parenteral meglumine, heat therapy, topical liposomal azithromycin, intralesional meglumine/silver dressing, intralesional sodium stibogluconate, parenteral meglumine/intralesional meglumine, oral allopurinol/parenteral meglumine, topical trichloroacetic acid/heat therapy, oral zinc sulphate/oral ketoconazole, topical imiquimod/cryotherapy, intralesional meglumine/cryotherapy, topical herbal extract of Z-HE, parenteral pentamidine, topical trichloroacetic acid/intralesional meglumine, carbon-dioxide laser, topical recombinant granulocyte-macrophage colony-stimulating factor/parenteral meglumine, intralesional dapsone, carbon-dioxide laser/intralesional meglumine, moist wet dressing with sodium hypochlorite, parenteral sodium stibogluconate/intralesional recombinant granulocyte-macrophage colony-stimulating factor, oral dapsone, intralesional sodium stibogluconate/oral ketoconazole, intralesional sodium stibogluconate/parenteral sodium stibogluconate and electrocautery/moist wet dressing with sodium hypochlorite were observed with significantly greater proportion of patients with complete cure compared to placebo/untreated controls. Rankogram analysis revealed that parenteral pentamidine has the highest statistical probability of being the best in the pool.
Conclusion:
We observed several interventions to be effective for treating cutaneous leishmaniasis. However, greater caution is required in interpreting the results as the estimates are likely to change with the advent of results from future studies.
Insights
Parenteral pentamidine emerged as the most effective treatment for cutaneous leishmaniasis in a network meta-analysis of 131 studies. Several other interventions also showed significant efficacy compared to placebo, highlighting diverse treatment options for this parasitic skin infection.
Area of Science:
- Dermatology
- Infectious Diseases
- Parasitology
Background:
- Cutaneous leishmaniasis (CL) is a neglected tropical disease with various treatment options.
- Existing therapies for CL include laser therapy, heat therapy, and multiple drugs.
- A lack of evidence-based comparisons necessitates a comprehensive meta-analysis of CL interventions.
Purpose of the Study:
- To conduct a network meta-analysis comparing the efficacy and safety of diverse interventions for cutaneous leishmaniasis.
- To identify the optimal treatment strategy for CL based on available randomized clinical trial data.
Main Methods:
- Systematic search of electronic databases for randomized clinical trials on CL interventions.
- Primary outcome: proportion of patients achieving complete cure.
- Secondary outcomes: lesion cure rates, treatment response, and wound changes. Random-effects modeling and rankogram analysis were employed.
Main Results:
- 131 studies were included, evaluating numerous interventions for CL.
- Multiple treatments, including parenteral pentamidine, topical paromomycin/gentamicin, and intralesional meglumine, demonstrated significantly higher complete cure rates than placebo.
- Rankogram analysis indicated parenteral pentamidine as the most statistically probable superior intervention.
Conclusions:
- Several interventions are effective for treating cutaneous leishmaniasis.
- Parenteral pentamidine shows the highest probability of being the most effective treatment.
- Results should be interpreted with caution, as future studies may alter current estimates.
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