Low versus high dose of antimony for American cutaneous leishmaniasis: a randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

dc.creatorSaheki, Mauricio Naoto
dc.creatorLyra, Marcelo Rosandiski
dc.creatorBedoya-Pacheco, Sandro Javier
dc.creatorAntônio, Liliane de Fátima
dc.creatorPimentel, Maria Inês Fernandes
dc.creatorSalgueiro, Mariza de Matos
dc.creatorVasconcellos, Érica de Camargo Ferreira e
dc.creatorPassos, Sonia Regina Lambert
dc.creatorSantos, Ginelza Peres Lima dos
dc.creatorRibeiro, Madelon Novato
dc.creatorFagundes, Aline
dc.creatorMadeira, Maria de Fátima
dc.creatorMouta-Confort, Eliame
dc.creatorMarzochi, Mauro Célio de Almeida
dc.creatorValete-Rosalino, Cláudia Maria
dc.creatorSchubach, Armando de Oliveira
dc.date2019-07-25T12:37:09Z
dc.date2019-07-25T12:37:09Z
dc.date2017
dc.date.accessioned2023-09-26T20:25:11Z
dc.date.available2023-09-26T20:25:11Z
dc.identifierSAHEKI, Mauricio Naoto et al. Low versus high dose of antimony for American cutaneous leishmaniasis: a randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil. Plos One, p. 1-20, May 2017.
dc.identifier1932-6203
dc.identifierhttps://www.arca.fiocruz.br/handle/icict/34410
dc.identifier10.1371/journal.pone.0178592
dc.identifier1932-6203
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/8856482
dc.descriptionBackground: Although high dose of antimony is the mainstay for treatment of American cutaneous leishmaniasis (ACL), ongoing major concerns remain over its toxicity. Whether or not low dose antimony regimens provide non-inferior effectiveness and lower toxicity has long been a question of dispute. Methods: A single-blind, non-inferiority, randomized controlled trial was conducted comparing high dose with low dose of antimony in subjects with ACL treated at a referral center in Rio de Janeiro, an endemic area of Leishmania (Viannia) braziliensis transmission. The primary outcome was clinical cure at 360 days of follow-up in the modified-intention-to-treat (mITT) and per-protocol (PP) populations. Non-inferiority margin was 15%. Secondary objectives included occurrence of epithelialization, adverse events and drug discontinuations. This study was registered in ClinicalTrials.gov: NCT01301924. Results: Overall, 72 patients were randomly assigned to one of the two treatment arms during October 2008 to July 2014. In mITT, clinical cure was observed in 77.8% of subjects in the low dose antimony group and 94.4% in the high dose antimony group after one series of treatment (risk difference 16.7%; 90% CI, 3.7–29.7). The results were confirmed in PP analysis, with 77.8% of subjects with clinical cure in the low dose antimony group and 97.1% in the high dose antimony group (risk difference 19.4%; 90% CI, 7.1–31.7). The upper limit of the confidence interval exceeded the 15% threshold and was also above zero supporting the hypothesis that low dose is inferior to high dose of antimony after one series of treatment. Nevertheless, more major adverse events, a greater number of adverse events and major adverse events per subject, and more drug discontinuations were observed in the high dose antimony group (all p<0.05). Interestingly, of all the subjects who were originally allocated to the low dose antimony group and were followed up after clinical failure, 85.7% achieved cure after a further treatment with local therapy or low dose of antimony. Conclusions: Compared with high dose, low dose of antimony was inferior at the pre-specified margin after one series of treatment of ACL, but was associated with a significantly lower toxicity. While high dose of antimony should remain the standard treatment for ACL, low dose antimony treatment might be preferred when toxicity is a primary concern.
dc.formatapplication/pdf
dc.languageeng
dc.publisherPublic Library of Science
dc.rightsopen access
dc.subjectAmerican cutaneous leishmaniasis
dc.subjectAntimony
dc.subjectRio de Janeiro
dc.subjectBrazil
dc.titleLow versus high dose of antimony for American cutaneous leishmaniasis: a randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil
dc.typeArticle


Este ítem pertenece a la siguiente institución