脂质体两性霉素 B 与其他疗法治疗黏膜利什曼病的对比研究：一项 15 年回顾性队列研究。
Comparative study on liposomal amphotericin B and other therapies in the treatment of mucosal leishmaniasis: A 15-year retrospective cohort study.
机构信息
Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brasil.
School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brasil.
出版信息
PLoS One. 2019 Jun 26;14(6):e0218786. doi: 10.1371/journal.pone.0218786. eCollection 2019.
BACKGROUND
Liposomal amphotericin B (L-AMB) has been used for mucosal leishmaniasis (ML), but comparative studies on L-AMB and other drugs used for the treatment of ML have not been conducted. The present study aimed to evaluate the outcome of patients with ML who were treated with L-AMB.
METHODS
This is a 15-year retrospective study of Brazilian patients with a confirmed diagnosis of ML. The therapeutic options for the treatment of ML consisted of L-AMB, amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (d-AMB), itraconazole, antimonial pentavalent, or pentamidine. Healing, cure rate and adverse effects (AEs) associated with the drugs used to treat this condition were analyzed.
RESULTS
In 71 patients, a total of 105 treatments were evaluated. The outcome of the treatment with each drug was compared, and results showed that L-AMB was superior to other therapeutic regimens (P = 0.001; odds ratio [OR] = 4.84; 95% confidence interval [CI] = 1.78-13.17). d-AMB had worse AEs than other treatment regimens (P = 0.001, OR = 0.09; 95% CI = 0.09-0.43). Approximately 66% of the patients presented with AEs during ML treatment. Although L-AMB was less nephrotoxic than d-AMB, it was associated with acute kidney injury compared with other drugs (P <0.05).
CONCLUSION
L-AMB was more effective than other therapies for the treatment of ML. However, a high incidence of toxicity was associated with its use. Therapeutic choices should be reassessed, and the development of new drugs is necessary for the treatment of ML.
背景
脂质体两性霉素 B（L-AMB）已被用于治疗黏膜利什曼病（ML），但尚未对 L-AMB 与用于治疗 ML 的其他药物进行比较研究。本研究旨在评估使用 L-AMB 治疗 ML 的患者的结局。
方法
这是一项对巴西 ML 确诊患者进行的 15 年回顾性研究。ML 的治疗选择包括 L-AMB、两性霉素 B 脂质复合物（ABLC）、去氧胆酸两性霉素 B（d-AMB）、伊曲康唑、五价锑剂或戊脒。分析了用于治疗这种疾病的药物的愈合、治愈率和不良反应（AE）。
结果
在 71 例患者中，共评估了 105 次治疗。比较了每种药物的治疗结果，结果表明 L-AMB 优于其他治疗方案（P=0.001；比值比[OR] = 4.84；95%置信区间[CI] = 1.78-13.17）。d-AMB 的 AE 比其他治疗方案更差（P=0.001，OR = 0.09；95%CI = 0.09-0.43）。大约 66%的患者在 ML 治疗期间出现 AE。尽管 L-AMB 的肾毒性小于 d-AMB，但与其他药物相比，它与急性肾损伤有关（P <0.05）。
结论
L-AMB 比其他疗法更有效治疗 ML。然而，其使用与高毒性发生率相关。需要重新评估治疗选择，并且需要开发新药来治疗 ML。
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