Interventions for American cutaneous and mucocutaneous leishmaniasis: a systematic review update

Ludovic Reveiz, Ana Nilce Silveira Maia-Elkhoury, Rubén Santiago Nicholls, Gustavo Adolfo Sierra Romero, Zaida E Yadon, Ludovic Reveiz, Ana Nilce Silveira Maia-Elkhoury, Rubén Santiago Nicholls, Gustavo Adolfo Sierra Romero, Zaida E Yadon

Abstract

Introduction: Leishmaniasis is an important public health problem in the Americas. A Cochrane review published in 2009 analyzed 38 randomized controlled trials (RCT). We conducted a systematic review to evaluate the effects of therapeutic interventions for American cutaneous and mucocutaneous leishmaniasis.

Methods: All studies were extracted from PubMed, Embase, Lilacs (2009 to July, 2012 respectively), the Cochrane Central Register of Controlled Trials (6-2012) and references of identified publications. RCTs' risk of bias was assessed.

Results: We identified 1865 references of interest; we finally included 10 new RCTs. The risk of bias scored low or unclear for most domains. Miltefosine was not significantly different from meglumine antimoniate in the complete cure rate at 6 months (4 RCT; 584 participants; ITT; RR: 1.12; 95%CI: 0.85 to 1.47; I2 78%). However a significant difference in the rate of complete cure favoring miltefosine at 6 months was found in L. panamensis and L. guyanensis (2 RCTs, 206 participants; ITT; RR: 1.22; 95%CI: 1.02 to 1.46; I2 0%). One RCT found that meglumine antimoniate was superior to pentamidine in the rate of complete cure for L. braziliensis (80 participants, ITT; RR: 2.21; 95%CI: 1.41 to 3.49), while another RCT assessing L. guyanensis did not find any significant difference. Although meta-analysis of three studies found a significant difference in the rate of complete cure at 3 months favoring imiquimod versus placebo (134 participants; ITT; RR: 1.45; 95%CI: 1.12 to 1.88; I2 0%), no significant differences were found at 6 and 12 months. Thermotherapy and nitric oxide were not superior to meglumine antimoniate.

Conclusion: Therapeutic interventions for American cutaneous and mucocutaneous leishmaniasis are varied and should be decided according to the context. Since mucosal disease is the more neglected form of leishmaniasis a multicentric trial should be urgently considered.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow Diagram from a Systematic…
Figure 1. Flow Diagram from a Systematic Review.
Figure 2. Meta-analysis of four RCTs assessing…
Figure 2. Meta-analysis of four RCTs assessing miltefosine compared to meglumine antimoniate in the complete cure rate at 6 months of follow up.
Figure 3. Meta-analysis of five studies assessing…
Figure 3. Meta-analysis of five studies assessing miltefosine compared to meglumine antimoniate in clinical failure at 6 months of follow up.
Figure 4. Meta-analysis of the three studies…
Figure 4. Meta-analysis of the three studies evaluating imiquimod compared to placebo in the rate of complete cure at 3 months of follow up.

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