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Miltefosine may serve as first-line treatment for leishmaniasis
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Miltefosine was well-tolerated and effectively treated complicated Old World cutaneous and mucosal leishmaniasis, making it an ideal first-line treatment option, according to findings published in Open Forum Infectious Diseases.
There are four compounds that currently are available to treat leishmaniasis, a parasitic disease transmitted through bites of infected sand flies, according to the CDC. The compounds include parenterally administered pentavalent antimonial and amphotericin B, and orally administered fluconazole and miltefosine. Due to a lack of clinical trials comparing the efficacy of the agents, physicians typically assign treatment regimens based on personal experience, drug availability and cost, according to Vincent Mosimann, MD, from the Swiss Tropical and Public Health Institute, and colleagues.
To gather more information, the researchers evaluated results from several studies that examined the agents. They found that pentavalent antimonials were associated with high toxicity and achieved a cure rate between 52% and 87% for Leishmania major, and 41% to 55% for L. donovani. Meanwhile, liposomal amphotericin B had a cure rate of 84% for L. tropica, although the researchers noted the agent can be costly, and fluconazole was associated with inconsistent efficacy and led to an increase in adverse events with higher dosages. The highest cure rate was observed with miltefosine, the newest leishmaniasis treatment, which cured a mean of 93% of L. major cases.
To further investigate the value of miltefosine, Mosimann and colleagues examined seven patients with complicated Old World cutaneous (OWCL) and mucosal leishmaniasis (OWML) at their institution and 17 cases published in literature who were treated with the agent. Most patients received 100 mg to 150 mg of miltefosine for 28 days for the treatment of L. major, L. donovani, L. infantum, L. aethiopica or L. tropica.
All patients completed their treatment regimens, reflecting the high tolerability of miltefosine, and showed clinical improvement, according to the researchers. During a 10-month duration, relapses occurred in two immunosuppressed patients with underlying ankylosing spondylitis and Good’s syndrome.
“Since pentavalent antimonials are relatively toxic and show limited cure rates and fluconazole has questionable efficacy, liposomal amphotericin B and miltefosine appear to be viable and the most promising treatment options for complicated OWCL and OWML,” Mosimann and colleagues concluded. “Because of easy oral administration, the overall good tolerability and the promising results, miltefosine may be considered as a first-line treatment for complicated OWCL and OWML.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
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