Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Dental Training Department, Ministry of Health, Manama, Kingdom of Bahrain.
Acta Trop. 2021 Aug;220:105944. doi: 10.1016/j.actatropica.2021.105944. Epub 2021 May 3.
INTRODUCTION: Various interventions including laser therapy, heat therapy, and several drugs have been trialed in patients with cutaneous leishmaniasis. Due to the lack of an evidence-based comparison of all these interventions, we carried out the present network meta-analysis. METHODS: Electronic databases were searched for randomized clinical trials evaluating the efficacy and safety of any interventions in patients with cutaneous leishmaniasis. The proportion of patients with complete cure was the primary outcome. The proportion of lesions cured at the end of treatment, the proportion of lesions with minimal/no response to treatment, and proportion of wounds with minimal/no change were the secondary outcomes. Random-effects modeling was used for generating pooled estimates. Rankogram plot was used for identifying the 'best intervention'. For interventions containing a combination of treatments, backslash (/) has been used for depicting the same. RESULTS: One-hundred and thirty-one studies were included. Intralesional meglumine, topical paromomycin/gentamicin, topical paromomycin, parenteral sodium stibogluconate, topical honey/intralesional meglumine, topical liposomal amphotericin B, oral zinc sulphate, oral miltefosine, parenteral meglumine, heat therapy, topical liposomal azithromycin, intralesional meglumine/silver dressing, intralesional sodium stibogluconate, parenteral meglumine/intralesional meglumine, oral allopurinol/parenteral meglumine, topical trichloroacetic acid/heat therapy, oral zinc sulphate/oral ketoconazole, topical imiquimod/cryotherapy, intralesional meglumine/cryotherapy, topical herbal extract of Z-HE, parenteral pentamidine, topical trichloroacetic acid/intralesional meglumine, carbon-dioxide laser, topical recombinant granulocyte-macrophage colony-stimulating factor/parenteral meglumine, intralesional dapsone, carbon-dioxide laser/intralesional meglumine, moist wet dressing with sodium hypochlorite, parenteral sodium stibogluconate/intralesional recombinant granulocyte-macrophage colony-stimulating factor, oral dapsone, intralesional sodium stibogluconate/oral ketoconazole, intralesional sodium stibogluconate/parenteral sodium stibogluconate and electrocautery/moist wet dressing with sodium hypochlorite were observed with significantly greater proportion of patients with complete cure compared to placebo/untreated controls. Rankogram analysis revealed that parenteral pentamidine has the highest statistical probability of being the best in the pool. CONCLUSION: We observed several interventions to be effective for treating cutaneous leishmaniasis. However, greater caution is required in interpreting the results as the estimates are likely to change with the advent of results from future studies.
简介:各种干预措施,包括激光疗法、热疗和几种药物,已在皮肤利什曼病患者中进行了试验。由于缺乏对所有这些干预措施的循证比较,我们进行了本次网络荟萃分析。
方法:电子数据库中检索了评估皮肤利什曼病患者任何干预措施疗效和安全性的随机临床试验。完全治愈的患者比例为主要结局。治疗结束时治愈的病变比例、对治疗有最小/无反应的病变比例和最小/无变化的伤口比例为次要结局。采用随机效应模型生成汇总估计值。秩图用于识别“最佳干预措施”。对于包含多种治疗方法的干预措施,反斜杠(/)用于表示相同的治疗方法。
结果:共纳入 131 项研究。病灶内注射氨苯砜、局部注射庆大霉素/硫酸新霉素、局部注射硫酸新霉素、静脉注射葡萄糖酸锑钠、局部注射蜂蜜/病灶内注射氨苯砜、局部注射脂质体两性霉素 B、口服硫酸锌、口服米替福新、静脉注射氨苯砜、热疗、局部注射脂体阿奇霉素、病灶内注射氨苯砜/银敷料、病灶内注射葡萄糖酸锑钠、静脉注射氨苯砜/病灶内注射氨苯砜、口服别嘌呤醇/静脉注射氨苯砜、局部注射三氯乙酸/热疗、口服硫酸锌/酮康唑、局部注射咪喹莫特/冷冻疗法、病灶内注射氨苯砜/冷冻疗法、局部注射 Z-HE 草药提取物、静脉注射戊烷脒、局部注射三氯乙酸/病灶内注射氨苯砜、二氧化碳激光、局部注射重组粒细胞-巨噬细胞集落刺激因子/静脉注射氨苯砜、病灶内注射氨苯砜、二氧化碳激光/病灶内注射氨苯砜、含次氯酸钠的湿敷料、静脉注射葡萄糖酸锑钠/病灶内注射重组粒细胞-巨噬细胞集落刺激因子、口服氨苯砜、病灶内注射葡萄糖酸锑钠/酮康唑、病灶内注射葡萄糖酸锑钠/静脉注射葡萄糖酸锑钠和电灼/含次氯酸钠的湿敷料与安慰剂/未治疗对照组相比,有更高比例的患者完全治愈。秩图分析显示,静脉注射戊烷脒最有可能成为最佳治疗方法。
结论:我们观察到几种干预措施对治疗皮肤利什曼病有效。然而,由于随着未来研究结果的出现,估计值可能会发生变化,因此需要更加谨慎地解释结果。
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