Favorable responses to treatment with 5 mg Sbv/kg/day meglumine antimoniate in patients with American tegumentary leishmaniasis acquired in different Brazilian regions

• Main Authors: Jamyra Iglesias Cataldo, Fátima Conceição-Silva, Liliane de Fátima Antônio, Armando de Oliveira Schubach, Mauro Célio de Almeida Marzochi, Cláudia Maria Valete-Rosalino, Maria Inês Fernandes Pimentel, Marcelo Rosandiski Lyra, Raquel de Vasconcellos Carvalhaes de Oliveira, Juliana Helena da Silva Barros, Raquel da Silva Pacheco, Maria de Fátima Madeira
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT)
• Series: Revista da Sociedade Brasileira de Medicina Tropical
• Subjects: American tegumentary leishmaniasis; Leishmania spp.; Leishmania (Viannia) braziliensis subpopulations; Therapy; Meglumine antimoniate; Low-dose
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822018000600769&lng=en&tlng=en

Abstract INTRODUCTION: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS: One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.