5 years ago

Amphotericin B for treatment of visceral leishmaniasis; a systematic review and meta-analysis of prospective, comparative clinical studies including dose ranging studies

The aim of this review is to evaluate the evidence for use of different formulations of amphotericin B, minimum effective dose for each formulation and its comparative efficacy against other drugs in achieving definitive cure of visceral leishmaniasis. Methods This systematic review and meta-analysis included following data sources; PubMed, EMBASE, Scopus, Web of Science and CINAHL. Controlled prospective clinical trials (randomized or non-randomized, including dose ranging studies) conducted between 1996 and 2017, with at least one treatment group receiving amphotericin B were included (published data only). The primary outcome was definitive cure at 6 months. Adverse events and mortality were assessed as secondary outcomes. The PROSPERO registration number for this review is CRD42017067488. Results Thirty one studies (26 were from India) that enrolled 6903 patients into 84 study groups met the selection criteria. In India, liposomal amphotericin B was not inferior to amphotericin B deoxycholate (RR: 1.00, 95% CI: 0.96 – 1.03, 2 RCTs, 514 participants, high quality evidence) and a single dose of the earlier formulation as low as 3.75mg/kg achieved a cure rate over 89% (95% CI: 70.6-97.2%). Amphotericin B deoxycholate was as effective as miltefosine (RR: 0.99, 95% CI: 0.95 – 1.03, 2 trials, 523 participants, high quality evidence) and may be better than paromomycin (RR: 1.04, 95% CI: 1.02 – 1.07, 1 trial, 667 participants, low quality evidence) in achieving definitive cure. Conclusions Amphotericin B is an efficacious drug in the Indian subcontinent. Further evidence is needed from prospective clinical trials in other endemic geographical regions.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17306389

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