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Epidemiology and Health 2019;e2019011.
DOI: https://doi.org/10.4178/epih.e2019011    [Accepted] Published online March 31, 2019.
Efficacy of miltefosine compared with glucantime for the treatment of cutaneous leishmaniasis: a systematic review and meta-analysis
Sohrab Iranpour1,3  , Ali Hosseinzadeh2  , Abbas Alipour3 
1Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Research Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Correspondence  Sohrab Iranpour ,Tel: 045-33521047, Email: sohrabiranpour@gmail.com
Received: March 1, 2019  Accepted after revision: March 31, 2019
The objective of this paper is a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime in the treatment of Cutaneous leishmaniasis (CL).
We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, CENTRAL, ICTRP, Sid, irandoc, magiran, and clinicaltrials.gov. We used the following keywords: “miltefosine”, “glucantime”, and “Leishmania”. The quality of studies was assessed using the Cochrane Risk of Bias Tool. A random-effects model was employed for analysis. We assessed heterogeneity by the chi2 test and I2 index statistic. When heterogeneity was present, meta-regression analyses were performed. Egger’s method was used to assess publication bias; when it was significant, the trim and fill method was used for testing and adjusting publication bias. A total of 1570 reports were identified, of which 10 studies were included in the meta-analysis.
In the meta-analysis, there was not a significant difference between the efficacies of miltefosine and glucantime; however, subgroup analysis showed that, regarding the parasite species other than L. braziliensis, miltefosine was significantly superior to glucantime (Intent to treat; RR:1.15; 95% CI:1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p= 0.1 level. Egger’s test found statistically significant publication bias; however, including the three missing studies in the trim and fill analysis did not change the results.
This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.
Keywords: Efficacy; miltefosine; glucantime; Cutaneous leishmaniasis; systematic review; meta-analyses


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