An analysis of local therapeutic treatments for cutaneous and mucocutaneous leishmaniasis: A systematic review and meta-analysis

Summary: Abstract Body: Cutaneous and mucocutaneous leishmaniasis are protozoan parasitic diseases characterized by skin and mucosal lesions. While FDA-approved amphotericin B demonstrates an efficacy rate of 74%, it is an invasive systemic treatment yielding severe adverse effects including nephrotoxicity. Conversely, heat therapies and cryotherapy, while yielding similar outcomes, are cost-effective and have stronger safety profiles.This systematic review and meta-analysis aim to compare the efficacy of amphotericin B with the emerging treatments thermotherapy and cryotherapy in patients with cutaneous and mucocutaneous leishmaniasis. This study seeks to standardize treatment protocols for these underrepresented therapies in clinical trials as leishmaniasis cases may rise in North America attributed to 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 from 2010 to 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 gaps or solutions in current treatment options were included, while studies lacking clear clinical cure outcomes were excluded. Both peer-reviewed and grey literature in English were included. By addressing the current research gap, this review aims to improve treatment options and 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. Minoritized Populations and Health Disparities Research