We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
A randomized, open-label study to evaluate the efficacy and safety of liposomal amphotericin B (AmBisome) versus miltefosine in patients with post-kala-azar dermal leishmaniasis.
- Authors
Pandey, Krishna; Pal, Biplab; Siddiqui, Niyamat Ali; Lal, Chandra Shekhar; Ali, Vahab; Bimal, Sanjiva; Kumar, Ashish; Verma, Neena; Rabi Das, Vidya Nand; Singh, Shubhankar Kumar; Topno, Roshan Kamal; Das, Pradeep; Pandey, Krishna; Das, Vidya Nand Rabi
- Abstract
<bold>Background: </bold>Treatment of post-kala-azar dermal leishmaniasis cases is of paramount importance for kala-azar elimination; however, limited treatment regimens are available as of now.<bold>Aim: </bold>To compare the effectiveness of liposomal amphotericin B vs miltefosine in post-kala-azar dermal leishmaniasis patients.<bold>Methodology: </bold>This was a randomized, open-label, parallel-group study. A total of 100 patients of post kala azar dermal leishmaniasis, aged between 5 and 65 years were recruited, 50 patients in each group A (liposomal amphotericin B) and B (miltefosine). Patients were randomized to receive either liposomal amphotericin B (30 mg/kg), six doses each 5 mg/kg, biweekly for 3 weeks or miltefosine 2.5 mg/kg or 100 mg/day for 12 weeks. All the patients were followed at 3rd, 6th and 12th months after the end of the treatment.<bold>Results: </bold>In the liposomal amphotericin B group, two patients were lost to follow-up, whereas four patients were lost to follow-up in the miltefosine group. The initial cure rate by "intention to treat analysis" was 98% and 100% in liposomal amphotericin B and miltefosine group, respectively. The final cure rate by "per protocol analysis" was 74.5% and 86.9% in liposomal amphotericin B and miltefosine, respectively. Twelve patients (25.5%) in the liposomal amphotericin B group and six patients (13%) in the miltefosine group relapsed. None of the patients in either group developed any serious adverse events.<bold>Limitations: </bold>Quantitative polymerase chain reaction was not performed at all the follow-up visits and sample sizes.<bold>Conclusion: </bold>Efficacy of miltefosine was found to be better than liposomal amphotericin B, hence, the use of miltefosine as first-line therapy for post-kala-azar dermal leishmaniasis needs to be continued. However, liposomal amphotericin B could be considered as one of the treatment options for the elimination of kala-azar from the Indian subcontinent.
- Subjects
SOUTH Asia; AMPHOTERICIN B; DRUG efficacy; LEISHMANIASIS; VISCERAL leishmaniasis; POLYMERASE chain reaction; MUCORMYCOSIS; MILTEFOSINE
- Publication
Indian Journal of Dermatology, Venereology & Leprology, 2021, Vol 87, Issue 1, p34
- ISSN
0378-6323
- Publication type
journal article
- DOI
10.25259/IJDVL_410_19