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Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials.

Kim DH, Chung HJ, Bleys J, Ghohestani RF - PLoS Negl Trop Dis (2009)

Bottom Line: Systemic side effects were fewer with topical or parenteral PR than parenteral SbV.Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL.Development of new formulations with better efficacy and tolerability remains to be an area of future research.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.

ABSTRACT

Background: High cost, poor compliance, and systemic toxicity have limited the use of pentavalent antimony compounds (SbV), the treatment of choice for cutaneous leishmaniasis (CL). Paromomycin (PR) has been developed as an alternative to SbV, but existing data are conflicting.

Methodology/principal findings: We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, without language restriction, through August 2007, to identify randomized controlled trials that compared the efficacy or safety between PR and placebo or SbV. Primary outcome was clinical cure, defined as complete healing, disappearance, or reepithelialization of all lesions. Data were extracted independently by two investigators, and pooled using a random-effects model. Fourteen trials including 1,221 patients were included. In placebo-controlled trials, topical PR appeared to have therapeutic activity against the old world and new world CL, with increased local reactions, when used with methylbenzethonium chloride (MBCL) compared to when used alone (risk ratio [RR] for clinical cure, 2.58 versus 1.01: RR for local reactions, 1.60 versus 1.07). In SbV-controlled trials, the efficacy of topical PR was not significantly different from that of intralesional SbV in the old world CL (RR, 0.70; 95% confidence interval, 0.26-1.89), whereas topical PR was inferior to parenteral SbV in treating the new world CL (0.67; 0.54-0.82). No significant difference in efficacy was found between parenteral PR and parenteral SbV in the new world CL (0.88; 0.56-1.38). Systemic side effects were fewer with topical or parenteral PR than parenteral SbV.

Conclusions/significance: Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL. Development of new formulations with better efficacy and tolerability remains to be an area of future research.

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Related in: MedlinePlus

Influence of Study Quality Criteria on Pooled Estimates*.* Pooled RRs and 95% CIs of clinical cure were calculated by study quality components, using an inverse-variance weighted random-effects model. † Adjusted for paromomycin regimen among trials with placebo control group and for antimony regimen among trials with pentavalent antimony compound control group.
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pntd-0000381-g004: Influence of Study Quality Criteria on Pooled Estimates*.* Pooled RRs and 95% CIs of clinical cure were calculated by study quality components, using an inverse-variance weighted random-effects model. † Adjusted for paromomycin regimen among trials with placebo control group and for antimony regimen among trials with pentavalent antimony compound control group.

Mentions: Concealment of treatment allocation was adequate in six trials [3],[16],[32],[34],[35],[37] and outcome assessment was blinded in five trials [3],[16],[28],[32],[34]. The intention-to-treat analysis was performed in five trials [4]–[6],[17],[35]. Trials that did not meet the study quality criteria tended to slightly exaggerate the efficacy of PR as compared to placebo or SbV. (Figure 4) In addition, the pooled estimates were not significantly changed when an individual trial was omitted. There was no evidence of publication bias based on the Begg's test and Egger's test (P = 0.621 and P = 0.126, respectively, for placebo-controlled trials; and P = 0.348 and P = 0.242, respectively, for SbV-controlled trials).


Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials.

Kim DH, Chung HJ, Bleys J, Ghohestani RF - PLoS Negl Trop Dis (2009)

Influence of Study Quality Criteria on Pooled Estimates*.* Pooled RRs and 95% CIs of clinical cure were calculated by study quality components, using an inverse-variance weighted random-effects model. † Adjusted for paromomycin regimen among trials with placebo control group and for antimony regimen among trials with pentavalent antimony compound control group.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2637543&req=5

pntd-0000381-g004: Influence of Study Quality Criteria on Pooled Estimates*.* Pooled RRs and 95% CIs of clinical cure were calculated by study quality components, using an inverse-variance weighted random-effects model. † Adjusted for paromomycin regimen among trials with placebo control group and for antimony regimen among trials with pentavalent antimony compound control group.
Mentions: Concealment of treatment allocation was adequate in six trials [3],[16],[32],[34],[35],[37] and outcome assessment was blinded in five trials [3],[16],[28],[32],[34]. The intention-to-treat analysis was performed in five trials [4]–[6],[17],[35]. Trials that did not meet the study quality criteria tended to slightly exaggerate the efficacy of PR as compared to placebo or SbV. (Figure 4) In addition, the pooled estimates were not significantly changed when an individual trial was omitted. There was no evidence of publication bias based on the Begg's test and Egger's test (P = 0.621 and P = 0.126, respectively, for placebo-controlled trials; and P = 0.348 and P = 0.242, respectively, for SbV-controlled trials).

Bottom Line: Systemic side effects were fewer with topical or parenteral PR than parenteral SbV.Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL.Development of new formulations with better efficacy and tolerability remains to be an area of future research.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.

ABSTRACT

Background: High cost, poor compliance, and systemic toxicity have limited the use of pentavalent antimony compounds (SbV), the treatment of choice for cutaneous leishmaniasis (CL). Paromomycin (PR) has been developed as an alternative to SbV, but existing data are conflicting.

Methodology/principal findings: We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, without language restriction, through August 2007, to identify randomized controlled trials that compared the efficacy or safety between PR and placebo or SbV. Primary outcome was clinical cure, defined as complete healing, disappearance, or reepithelialization of all lesions. Data were extracted independently by two investigators, and pooled using a random-effects model. Fourteen trials including 1,221 patients were included. In placebo-controlled trials, topical PR appeared to have therapeutic activity against the old world and new world CL, with increased local reactions, when used with methylbenzethonium chloride (MBCL) compared to when used alone (risk ratio [RR] for clinical cure, 2.58 versus 1.01: RR for local reactions, 1.60 versus 1.07). In SbV-controlled trials, the efficacy of topical PR was not significantly different from that of intralesional SbV in the old world CL (RR, 0.70; 95% confidence interval, 0.26-1.89), whereas topical PR was inferior to parenteral SbV in treating the new world CL (0.67; 0.54-0.82). No significant difference in efficacy was found between parenteral PR and parenteral SbV in the new world CL (0.88; 0.56-1.38). Systemic side effects were fewer with topical or parenteral PR than parenteral SbV.

Conclusions/significance: Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL. Development of new formulations with better efficacy and tolerability remains to be an area of future research.

Show MeSH
Related in: MedlinePlus