An analysis of chemotherapeutic treatment avenues for cutaneous and mucocutaneous leishmaniasis: A systematic review and meta-analysis

Summary: Abstract Body: Cutaneous and mucocutaneous leishmaniasis, a protozoan parasitic disease characterized by skin and mucosal lesions, is endemic to nearly 100 countries and impacts over 350 million people. Amphotericin B is an intravenous treatment notable for its high efficacy, achieving final cure rates of 74-87%, but presents risks of developing drug resistance, adverse effects, and systemic toxicities. Conversely, orally administered miltefosine has a slightly stronger safety profile and maybe a better treatment option.This systematic review and meta-analysis aim to evaluate the efficacy of amphotericin B compared to miltefosine in patients with cutaneous and mucocutaneous leishmaniasis, seeking to standardize treatment protocols North America as cases may arise due to the accelerating effects of climate change. The primary outcome measures the complete re-epithelialization of lesions, categorized as complete response, partial response, or failure, based on the percentage of re-epithelialization of the ulcer within a standardized timeframe and a secondary outcome measuring adverse effects of the treatments. A comprehensive initial search and manual snowball-method search were conducted across five peer-reviewed databases (PubMed, Medline, Scopus, LILACS, and Cochrane Library) for studies conducted between 2010 and 2024. All stages of screening, extraction, and quality appraisal using GRADE were performed in duplicate by blinded reviewers with a third independent reconciler. Studies focused on old and new world leishmaniasis were included and studies lacking a clear clinical cure outcome were excluded.The findings of this review will comparatively analyze amphotericin B and miltefosine, offering insights to guide future treatment guidelines for managing this disease. Joy Xu¹, Sophia Salazar², Aashita Doshi³, Jonathan Glass⁴ 1. University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States. 2. University of Toronto, Toronto, ON, Canada. 3. The University of Texas at Dallas School of Behavioral and Brain Sciences, Richardson, TX, United States. 4. Dartmouth Health, Lebanon, NH, United States. Clinical Research: Epidemiology and Observational Research