Drug regimens for visceral leishmaniasis in Mediterranean countries
Drug regimens for visceral leishmaniasis in Mediterranean countries
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DOI：
10.1111/j.1365-3156.2008.02144.x
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发表时间：
2008-10-01
影响因子：
3.3
通讯作者：
Dujardin, Jean-Claude
中科院分区：
文献类型：
--
作者：
Gradoni, Luigi;Soteriadou, Ketty;Dujardin, Jean-Claude
直到 20 世纪 90 年代初，五价锑是地中海地区唯一有记录的用于治疗人畜共患内脏利什曼病 (VL) 的一线药物，据报道，免疫功能正常患者的治愈率超过 95%。其他流行环境中锑耐药性的出现以及药物选择的增加促使人们重新评估地中海国家当前的治疗方法和结果。一个科学联盟（“LeishMed”网络）从南欧、北非和中东 11 个流行国家的合作临床卫生中心收集了最新信息。与以往的情况相比，该地区目前对VL的治疗有所不同，主要通过三种途径：（1）在北非和中东部分地区，五价锑仍然是治疗的主要手段，没有替代药物可供选择治疗复发； （2）在一些欧洲国家和以色列，五价锑和脂质相关两性霉素B（AmB）制剂均被用作一线药物，尽管针对不同的患者类别； (3)欧洲其他国家主要采用脂质体AmB。重要的是，不同药物（包括仍在常规使用的地区的锑剂）在免疫功能正常的患者中表现出的治愈率同样很高（>= 95%）。我们的研究结果表明，锑抗性并不是地中海地区新出现的问题。一个国家的财富会影响治疗选择，这代表了药物疗效、毒性和成本以及与患者护理相关的成本之间的平衡。
Until the early 1990s, pentavalent antimony was the only documented first-line drug employed for the treatment of zoonotic visceral leishmaniasis (VL) in the Mediterranean, with reported cure rates exceeding 95% in immunocompetent patients. The emergence of antimony resistance in other endemic settings and the increase in drug options have stimulated re-evaluation of the current therapeutic approaches and outcomes in Mediterranean countries. A scientific consortium ('LeishMed' network) collected updated information from collaborating clinical health centres of 11 endemic countries of Southern Europe, Northern Africa and the Middle East. In contrast with the previous situation, VL is now treated differently in the region, basically through three approaches: (1) In Northern Africa and in part of the Middle East, pentavalent antimony is still the mainstay for therapy, with no alternative drug options for treating relapses; (2) In some European countries and Israel, both pentavalent antimony and lipid-associated amphotericin B (AmB) formulations are used as first-line drugs, although in different patients' categories; (3) In other countries of Europe, mainly liposomal AmB is employed. Importantly, cure rates exhibited by different drugs, including antimonials in areas where they are still in routine use, are similarly high (>= 95%) in immunocompetent patients. Our findings show that antimony resistance is not an emerging problem in the Mediterranean. A country's wealth affects the treatment choice, which represents a balance between drug efficacy, toxicity and cost, and costs associated with patient's care.