Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Galvão, Endi Lanza
Data de Publicação: 2017
Outros Autores: Rabello, Ana Lucia Teles, Cota, Gláucia Fernandes
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/25322
Resumo: Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.
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spelling Galvão, Endi LanzaRabello, Ana Lucia TelesCota, Gláucia Fernandes2018-03-15T16:27:09Z2018-03-15T16:27:09Z2017GALVÃO, Endi Lanza; RABELLO, Ana Lucia Teles; COTA, Fernandes Cota. Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS One, v. 12, n. 10, p. 1-24, 2017.1932-6203https://www.arca.fiocruz.br/handle/icict/2532210.1371/journal.pone.0186117engPublic Library of ScienceLeishmanioseDoenças parasitáriasAzolesLeishmaniasisLesionsParasitic diseasesDrug therapyDatabase searchingEfficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysisinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleFundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Background: Several controlled and uncontrolled studies addressing azole antifungal drugs for cutaneous and mucosal leishmaniasis have been published with inconclusive results. We conducted a systematic literature review of studies evaluating the efficacy and toxicity associated with azole therapy for tegumentary leishmaniasis. Methodology: PRISMA guidelines for systematic reviews and the Cochrane manual were followed, and the review methodology was registered (PROSPERO; CRD42016048668). Sources included the EMBASE, Web of Science, MEDLINE, LILACS, and IBECS databases along with a manual search of references from evaluated studies. Additional resources such as Google Scholar and clinicaltrials.gov were also searched. We included all studies reporting cure rate after cutaneous or mucosal leishmaniasis treatment with systemic azole drugs, regardless of their design. R software was used to estimate global rates of success and adverse events with each drug. The main outcome of interest was clinical cure, defined as complete re-epithelialization of all lesions. Results: A total of 37 studies involving 1259 patients that reported outcomes after fluconazole (9), ketoconazole (14) and itraconazole (15) treatments were included. Only 14 (38%) were randomized controlled trials (RCT). The pooled azole final efficacy rate was 64% (CI95%: 57± 70%) for all studies and 60% (CI95%: 50±70%) (p = 0.41) if only RCTs studies were considered. Twenty-four studies were conducted in the Old World and 13 studies in the Americas. The final efficacy rate according to New and Old World were 62% (CI95%: 43±77%) and 66% (CI95%: 58±73%), respectively. The final efficacy rate of azoles according to species were 89% (CI95%: 50±98%) for L. mexicana; 88% for L. infantum (CI95%: 27±99%); 80% for L. donovani; 53% (CI95%: 29±76%) for L. major; 49% for L. braziliensis (CI95%: 21± 78%); and 15% (CI95%: 1±84%) for L. tropica. The cure rates were similar among the fluconazole, ketoconazole and itraconazole group arms (p = 0.89), specifically 61% (CI95%:48±72%), 64% (CI95%: 44±80%) 65% (CI95%: 56±72%), respectively. Adverse events during fluconazole, itraconazole and ketoconazole therapy were reported in 7% (CI95%: 3±14%), 12% (CI95% 8±19%) and 13% (CI95%: 6±29%) of treated patients, respectively,without difference among them (p = 0.35). This systematic review included studies with small samples and both non-comparative and non-randomized studies and the main limitation was the low quality of the available studies Conclusions: Available evidence suggests that fluconazole, ketoconazole and itraconazole have similar and modest efficacy rates for tegumentary leishmaniasis treatment. There is insufficient evidence to support the exclusive use of azole therapy as a single agent for leishmaniasis treatment.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83082https://www.arca.fiocruz.br/bitstream/icict/25322/1/license.txt9193a7c197bc67acd023525e72a03240MD51ORIGINALEfficacy of azole therapy for tegumentary.pdfEfficacy of azole therapy for tegumentary.pdfapplication/pdf849302https://www.arca.fiocruz.br/bitstream/icict/25322/2/Efficacy%20of%20azole%20therapy%20for%20tegumentary.pdffc4bbcb98f51f0009ab9f6957053a732MD52TEXTEfficacy of azole therapy for tegumentary.pdf.txtEfficacy of azole therapy for tegumentary.pdf.txtExtracted texttext/plain73056https://www.arca.fiocruz.br/bitstream/icict/25322/3/Efficacy%20of%20azole%20therapy%20for%20tegumentary.pdf.txt5dcdd48e6a907958ac584ce090fad3cbMD53icict/253222019-12-23 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dc.title.pt_BR.fl_str_mv Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
title Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
spellingShingle Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
Galvão, Endi Lanza
Leishmaniose
Doenças parasitárias
Azoles
Leishmaniasis
Lesions
Parasitic diseases
Drug therapy
Database searching
title_short Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
title_full Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
title_fullStr Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
title_full_unstemmed Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
title_sort Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis
author Galvão, Endi Lanza
author_facet Galvão, Endi Lanza
Rabello, Ana Lucia Teles
Cota, Gláucia Fernandes
author_role author
author2 Rabello, Ana Lucia Teles
Cota, Gláucia Fernandes
author2_role author
author
dc.contributor.author.fl_str_mv Galvão, Endi Lanza
Rabello, Ana Lucia Teles
Cota, Gláucia Fernandes
dc.subject.other.pt_BR.fl_str_mv Leishmaniose
Doenças parasitárias
topic Leishmaniose
Doenças parasitárias
Azoles
Leishmaniasis
Lesions
Parasitic diseases
Drug therapy
Database searching
dc.subject.en.pt_BR.fl_str_mv Azoles
Leishmaniasis
Lesions
Parasitic diseases
Drug therapy
Database searching
description Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.
publishDate 2017
dc.date.issued.fl_str_mv 2017
dc.date.accessioned.fl_str_mv 2018-03-15T16:27:09Z
dc.date.available.fl_str_mv 2018-03-15T16:27:09Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv GALVÃO, Endi Lanza; RABELLO, Ana Lucia Teles; COTA, Fernandes Cota. Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS One, v. 12, n. 10, p. 1-24, 2017.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/25322
dc.identifier.issn.pt_BR.fl_str_mv 1932-6203
dc.identifier.doi.none.fl_str_mv 10.1371/journal.pone.0186117
identifier_str_mv GALVÃO, Endi Lanza; RABELLO, Ana Lucia Teles; COTA, Fernandes Cota. Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS One, v. 12, n. 10, p. 1-24, 2017.
1932-6203
10.1371/journal.pone.0186117
url https://www.arca.fiocruz.br/handle/icict/25322
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Public Library of Science
publisher.none.fl_str_mv Public Library of Science
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
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