{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T01:10:18Z","timestamp":1792285818341,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010931","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000}}],"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["301384\/2019"],"award-info":[{"award-number":["301384\/2019"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Mucosal or mucocutaneous leishmaniasis is the most severe form of tegumentary leishmaniasis due to its destructive character and potential damage to respiratory and digestive tracts. The current treatment recommendations are based on low or very low-quality evidence, and pentavalent antimonial derivatives remain strongly recommended. The aim of this review was to update the evidence and estimate the cure rate and safety profile of the therapeutic options available for mucosal leishmaniasis (ML) in the Americas.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>A systematic review was conducted in four different databases and by different reviewers, independently, to evaluate the therapeutic efficacy and toxicity associated with different treatments for ML. All original studies reporting cure rates in more than 10 patients from American regions were included, without restriction of design, language, or publication date. The risk of bias was assessed by two reviewers, using different tools according to the study design. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. The protocol for this review was registered at the International Prospective Register of Systematic Reviews, PROSPERO: CRD42019130708.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Principal findings<\/jats:title>\n<jats:p>Twenty-seven original studies from four databases fulfilled the selection criteria. A total of 1,666 patients with ML were treated predominantly with pentavalent antimonials in Brazil. Other interventions, such as pentamidine, miltefosine, imidazoles, aminosidine sulfate, deoxycholate and lipidic formulations of amphotericin B (liposomal, lipid complex, colloidal dispersion), in addition to combinations with pentoxifylline, allopurinol or sulfa were also considered. In general, at least one domain with a high risk of bias was identified in the included studies, suggesting low methodological quality. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. It was confirmed that antimony is still the most used treatment for ML, with only moderate efficacy (possibly increased by combining with pentoxifylline). There is already evidence for the use of miltefosine for ML, with a cure rate similar to antimony, as observed in the only direct meta-analysis including 57 patients (OR: 1.2; 0.43\u20133.49, I<jats:sup>2<\/jats:sup> = 0). It was possible to gather all descriptions available about adverse events reported during ML treatment, and the toxicity reflected the pattern informed in the manufacturers\u2019 technical information.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study provides an overview of the clinical experience in the Americas related to ML treatment and points out interventions and possible combinations that are eligible to be explored in future well-designed studies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010931","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T19:18:37Z","timestamp":1668712717000},"page":"e0010931","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["The cure rate after different treatments for mucosal leishmaniasis in the Americas: A systematic review"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0875-3600","authenticated-orcid":true,"given":"Jana\u00edna de Pina","family":"Carvalho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Nascimento","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Louren\u00e7o","family":"Freire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00edndicy Leidicy","family":"Alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Senra Alves de","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gl\u00e1ucia","family":"Cota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"pntd.0010931.ref001","doi-asserted-by":"crossref","first-page":"266","DOI":"10.4269\/ajtmh.2007.77.266","article-title":"Treatment of Mucosal Leishmaniasis in Latin America: Systematic Review","volume":"77","author":"VS Amato","year":"2007","journal-title":"The American Journal of Tropical Medicine and Hygiene"},{"key":"pntd.0010931.ref002","volume-title":"Manual de vigil\u00e2ncia da leishmaniose tegumentar Americana","author":"Brasil, Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade","year":"2017","edition":"2"},{"key":"pntd.0010931.ref003","doi-asserted-by":"crossref","first-page":"e980","DOI":"10.1371\/journal.pntd.0000980","article-title":"Mucosal Leishmaniasis Caused by Leishmania (Viannia) braziliensis and Leishmania (Viannia) guyanensis in the Brazilian Amazon","volume":"5","author":"O Guerra JA de","year":"2011","journal-title":"PLOS Neglected Tropical Diseases"},{"key":"pntd.0010931.ref004","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4269\/ajtmh.1998.59.49","article-title":"Mucosal leishmaniasis due to Leishmania (Viannia) panamensis in Colombia: clinical characteristics","volume":"59","author":"LE Osorio","year":"1998","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0010931.ref005","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1179\/2047773213Y.0000000098","article-title":"Three Leishmania\/L. species\u2013L. infantum, L. major, L. tropica\u2013as causative agents of mucosal leishmaniasis in Iran","volume":"107","author":"S Shirian","year":"2013","journal-title":"Pathogens and Global Health"},{"key":"pntd.0010931.ref006","volume-title":"Control of the leishmaniases: report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22\u201326 March 2010","author":"WHO WHO","year":"2010"},{"key":"pntd.0010931.ref007","unstructured":"OPAS\/OMS OP-ADS \/ORGANIZA\u00c7\u00c3O MDS. 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