Efficacy of miltefosine in comparison with glucantime for treatment Cutaneous leishmaniasis: a systematic review and meta-analyses

Background and Aim: Cutaneous leishmaniasis (CL) is most common form of the disease that identified by ulcerative skin lesions. The objective of this paper is systematic review and meta-analyses of clinical trials which compared the efficacy of miltefosine and glucantime in treatment of CL. Materials and Methods: We searched the databases of Cochrane, pubmed, Embase, Scopus, web of science, proquest, CENTRAL, ICTRP, Sid, irandoc, magiran, clinicaltrials.gov (from1991 to 2017) using the keywords: miltefosine , glucantime , Leishmania . The quality of studies was assessed independently by 2 authors by using the Cochrane Risk of Bias Tool. The relevant data from the studies were extracted independently by two authors. We present summary estimates from efficacy analyses as relative risk (RR) and risk difference (RD). The random-effects model was employed for analysis. We assessed heterogeneity by Chi2 test and I2 index statistic. When heterogeneity was present, meta-regression analyses were performed. Sensitivity analysis was used to verify the reliability of the results. The Egger’s method was used for assessing the publication bias and when was significant then trim and fill method was used for testing and adjusting publication bias. The analysis was performed using STATA version 12.0. Results: A total of 1570 reports were identified of which, we included 10 studies in the meta-analyses. In Meta-analysis there was not a significant difference between efficacy of miltefosine and glucantime. Regarding of parasite species, In subgroup analysis with excluding the studies whit braziliensis, with polling the other 4 studies miltefosine was significantly superior to glucantime (Intent to treat (ITT); RR:1.15; 95% CI:1.01 to 1.32 - RD: 0.11; 95% CI: 0.01 to 0. 21; 293 participants;). Because of the I2 =56.8%, meta- regression analysis was conducted. The results of meta-regression were not significant, except for glucantime injection type in p= 0.1 level. The Egger’s test (t =3.35, P = 0.015) found statistically significant publication bias. Trim and fill analysis revealed that 3 study was missed or trimmed. However including of missing studies not changed the results.Conclusion: This meta-analysis found that miltefosine seems to be more effective than glucantime at least in species other than brazilinsis treating CL.

کلیدواژه ها:

Efficacy ، miltefosine ، glucantime ، Cutaneous leishmaniasis ، systematic review ، meta-analyses