Dados do Trabalho

Título

PENTAVALENT ANTIMONY ASSOCIATED WITH G-CSF IN THE TREATMENT OF CUTANEOUS LEISHMANIASIS CAUSED BY LEISHMANIA (V) BRAZILIENSIS

Introdução

Cutaneous leishmaniasis (CL) is the most common form of presentation of American Tegumentary Leishmaniasis (ATL). CL caused by Leishmania Viannia braziliensis has decreasing cure rates and long time to heal after treatment with systemic pentavalent antimony (Sbv) at a high dosage. It is known that inflammatory cytokines and CD8+ cytotoxic cells play an important role in the pathogenesis of the CL ulcer. Granulocyte colony stimulating factor (G-CSF) is associated with epithelialization and healing processes. G-CSF also induces IL-10-producing regulatory cells, in addition to negatively interfering with the function of CD8+ cytotoxic cells. Therefore, G-CSF is a potential candidate as an associated drug aiming to increase cure rates in CL treated with Sbv.

Objetivo (s)

To compare the efficacy and safety of the association between Sbv and G-CSF in the treatment of CL caused by L. braziliensis and to determine the immunological and inflammatory biomarkers of disease severity.

Material e Métodos

This double-blind randomized controlled study compares the efficacy of Sbv (Glucantime™, 20mg/kg/day intravenously for 20 days) associated whith G-CSF with Sbv plus placebo in the treatment of localized CL.Thirty-two patients aged between 18 and 50 years with CL (up to 3 lesions) confirmed by a positive PCR for L. braziliensis were included. G-CSF or placebo (0.9% saline solution) was applied by intralesional infiltration of 0.1 mL at 4 equidistant points on the edge of the largest ulcer on day 0 and 15. Cure was defined as complete healing without elevation of the ulcer borders on day 90 after initiation of therapy.

Resultados e Conclusão

Males predominated in the G-CSF group (59%), while the control group had a higher frequency of women (53.3%). Most of the lesions were located in the lower limbs. The cure rate in the G-CSF group was 53% and in the control group it was 47%. At the final assessment (day 180) the G-CSF the G-CSF group presented a higher cure rate than the placebo (82.4% versus 53.3%), not significant. Our data suggest that the use of G-CSF with standard therapy may improve treatment outcome in CL and avoid further Sbv courses.

Palavras-chave

Cutaneous leishmaniasis, treatment, granulocyte colony stimulating factor, pentavalent antimony, Leishmania Viannia braziliensis.

Agradecimentos

We thank the medical and administrative team of leishmaniasis in Corte de Pedra and the team of the Immunology Service of the Hospital Universitario Prof. Edgar Santos.
Financing: INCT-DT and MCTI/CNPq/CAPES/FAPS