Efficacy and Safety in the Treatment of Patients with Cutaneous Leishmaniasis of Intralesional Compared to Intramuscular or Intravenous Administration of Meglumine Antimony: a Systematic Review and Meta-Analysis

Purpose of Review: To determine the safety and efficacy of intralesional versus systemic (intramuscular/endovenous) application of meglumine antimony (MA) in cutaneous leishmaniasis (CL). Recent Findings: The search was conducted in CENTRAL, Pubmed, LILACS, Web of Science, Embase and Google Scholar. We included randomized clinical trials (RCTs) or non-randomized intervention studies (NIS), in any language, with patients with a laboratory diagnosis of CL; excluding: extracutaneous involvement, comorbidities, previous treatment with MA, pregnant or breastfeeding women. The GRADE system was used for the assessment of certainty of evidence (CoE). A total of 4 studies were included (2 RCTs and 2 NISs). Intralesional therapy showed greater efficacy than systemic therapy, with 14% more complete cures (RR=1.14; CoE: very low). Cure was 16 days faster with intralesional, but not statistically significant (95% CI -33 to 0.35; p=0.05; CoE: very low). There were no recurrences in either group. The intralesional route had fewer adverse events (RR=0.67; p<0.05 CoE: very low): clinical (RR=0.57; CoE: very low), laboratory (RR=0.36; CoE: low), electrocardiographic (RR=0.35; CoE: very low) and severe (RR=0.09; CoE: very low). Summary: Current evidence shows uncertainty regarding the efficacy and safety of intralesional administration of meglumine antimoniate compared to the systemic route in the treatment of cutaneous leishmaniasis. Registration: CRD42024628935 (PROSPERO).