Successful treatment of refractory cutaneous leishmaniasis with GM-CSF and antimonials.
Therapeutic failure in the treatment of cutaneous leishmaniasis (CL) occurs in 5% of patients infected by Leishmania braziliensis. This study evaluates the use of topically applied granulocyte macrophage colony-stimulating factor (GM-CSF) combined with the standard dose of antimony to treat refractory cases of CL. Five patients who had received three courses or more of antimony were enrolled in an open-label clinical trial. One to 2 mL of the GM-CSF solution (10 mug/mL in 0.9% saline) was reapplied topically, and dressings were changed three times per week for 3 weeks, associated with standard parenteral antimony (20 mg kg(-1) day(-1) for 20 days). All the patients healed their CL ulcers; 3 healed within 50 days (21, 27, and 44 days) and 2 in 118 and 120 days after beginning therapy. There were no side effects. This study shows that combined topically applied GM-CSF and antimony can be effective and well tolerated in the treatment of relapsed CL.
Almeida
Roque P
RP
Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Brito
Jussamara
J
Machado
Paulo L
PL
DE Jesus
Amélia R
AR
Schriefer
Albert
A
Guimarães
Luiz Henrique
LH
Carvalho
Edgar M
EM
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000818:Animals; D000965:Antimony / Q000627:therapeutic use; D001938:Brazil; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007892:Leishmania braziliensis; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy*; D008297:Male; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D000965:Antimony