[Leish-l] Warning: Drugs for human leishmaniasis used to treat dogs

Tue Dec 17 17:19:42 -03 2019

Tremendous work ! Congratulations ! I noted L infantum was isolated from
patients  in LIT and promastigotes were used for the work done. Have
amastigotes in rhe clinical samples been examined for the MSL ? May be, I
missed ?

KP

On Tue, Dec 17, 2019 at 1:36 PM Carlos Costa <chncosta at gmail.com> wrote:

> Dear,
>
> Long before the introduction of milteforan to dogs in Brazil, miltefosine
> was already poorly effective to treat VL in Brazil. Therefore, if strains
> resistant to miltefosine arise in dogs or human the treatment of dogs with
> milteforan is not to be blamed.
>
> Please check this attached paper.
>
> Cheers,
>
> Carlos.
>
> On Tue, Dec 17, 2019 at 1:06 PM BARTIRA BERGMANN <bartira at biof.ufrj.br>
> wrote:
>
>> Dear colleagues,
>>
>> In Brazil, the human use of miltefosine is not approved by the Ministry of
>> Health due to inconsistent efficacy in local VL human cases. Apparently
>> because it is not used in humans, miltefosine (Milteforan) was approved in
>> 2016 for use against canine VL. Here, Milteforan is to be given in
>> association with the leishmaniostatic alopurinol, and treatment repeated
>> every 6 months for life because of lack of sterile cure.
>>
>> Milteforan is very expensive in Brazil (~USD 300/ treatment), so it is
>> conceivable that many owners interrupt the lifelong treatment.  There is a
>> lot of merchandising pressure from both the industry and vet  clinics that
>> make a lot of money with the drug and periodical diagnostics, also very
>> expensive.
>>
>> I would not be surprised if miltefosine-resistant parasite strains are
>> already circulating in the country. That by itself should hamper
>> miltefosine approval against human CL, as recently considered by the
>> Ministry of Health based on a recent clinical trial, considering that many
>> dogs may be co-infected with VL and CL leishmanial species.
>>
>> With best regards,
>> Bartira Rossi-Bergmann
>>
>> On Thu, 5 Dec 2019 at 11:54, Rolando Oddone <roloddone at googlemail.com>
>> wrote:
>>
>> > Yes, Dr Kwang-Poo Chang. The position of health authorities and PAHO
>> > officials (at least in Paraguay) is to restrict the use of these drugs
>> only
>> > for human cases. The reason is obvious. As the Leishmania are not
>> totally
>> > killed by these drugs during treatment, they are creating resistance
>> > against these same drugs. Similar situation ocurred in India during the
>> > 1990's, with indiscriminate use of antimonials in humans. In some
>> regions
>> > of India, nearly 50% of VL cases (caused by L. donovani) were found
>> > resistant to SbV, therefore WHO speeded up the use of Miltefosine as
>> > alternative drug. But in our case, Miltefosine is not as useful as in
>> > India. It can cure VL cases (in Paraguay caused by L. infantum) but they
>> > easily relapse.
>> >
>> > The conclusions of the last WorldLeish in Spain were clear: there are no
>> > new drugs for leishmaniasis. If we are creating resistance of Leishmania
>> > against SbV, we will have very few options for all human cases. But if
>> dogs
>> > do not use antimonials, they can be treated by other drugs, as far as I
>> > understand.
>> >
>> >
>> > Rolando Oddone
>> >
>> >
>> > El mar., 5 de nov. de 2019 a la(s) 17:13, Kwang-Poo Chang (
>> > kwangpoo.chang at rosalindfranklin.edu) escribió:
>> >
>> > > Dear Rolando,
>> > >
>> > > Both drugs you mentioned have been used by veterinarians elsewhere for
>> > > treating canine leishmaniasis, although neither has been shown to cure
>> > the
>> > > disease. According to my colleagues in Naples, Italy, the diseased
>> dogs
>> > > responded positively to the treatment when used at high dosage
>> initially,
>> > > as indicated by a reduction of LD loads and alleviation of clinical
>> > > symptoms, but ~50% of them died of flare-ups eventually. Your concern
>> > seems
>> > > to be a regulatory issue of restricting the use of these drugs only
>> for
>> > > human cases in Paraguy ?
>> > >
>> > > Laura Manna is a DVM in Naples who has been trying our
>> > > photodynamically inactivated Leishmaina as non-viable whole-cell
>> vaccines
>> > > for immunotherapy of canine leishmaniasis after initial chemotherapy
>> with
>> > > evidence of some effectiveness. Let me know, should you or your
>> > colleagues
>> > > are interested in this ?
>> > >
>> > > KP
>> > >
>> > > Kwang Poo Chang, PhD
>> > > Professor of Microbiology/Immunology
>> > > Chicago Medical School/RFUMS
>> > > N Chicago, IL 60064, USA
>> > >
>> > > On Fri, Nov 1, 2019 at 4:40 PM Rolando Oddone <
>> roloddone at googlemail.com>
>> > > wrote:
>> > >
>> > >> In Paraguay we have growing proliferation of dogs with leishmaniasis
>> (L.
>> > >> infantum) since the 1990s.
>> > >> But dog owners with leishmaniasis are increasingly reluctant to
>> > sacrifice
>> > >> their animals. In recent years Glucantime and Milteforan are entering
>> > the
>> > >> country smuggled (apparently they come from France and Spain), for
>> > "free"
>> > >> use in dogs. These medications are currently being used
>> indiscriminately
>> > >> by
>> > >> veterinarians who, for profit, take advantage of the need that people
>> > have
>> > >> to want to preserve the lives of their pets.
>> > >> Under this scenario, hundreds of dogs have already been treated with
>> > these
>> > >> drugs, perhaps a thousand in a few years, and the magnitude of the
>> > problem
>> > >> will increase.
>> > >> However, the authorities of the Ministry of Health do not take any
>> > >> measures, despite the existence of recommendations that these drugs
>> are
>> > >> exclusively for human use.
>> > >> The purpose of this sharing is, dear colleagues, that you express
>> your
>> > >> position regarding this situation, at least in this way, and what
>> would
>> > be
>> > >> the impact this could have at the international level. Your joint
>> voice
>> > >> will be better heard than the simple complaint I may make.
>> > >>
>> > >>
>> > >> Rolando Oddone
>> > >> IICS-UNA
>> > >> Paraguay
>> > >> _______________________________________________
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>> > >>
>> > >> --
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>> > >>
>> > >
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>>
>>
>> --
>> *Bartira Rossi Bergmann*
>> Instituto de Biofísica Carlos Chagas Filho
>> Universidade Federal do Rio de Janeiro - Brasil
>> tel: +55 (21) 2260-6963
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>
>
> --
> Carlos H. N. Costa, MD, DSc.
> President
> Instituto de Doenças do Sertão
> *Instituto de Doenças Tropicais Natan Portella*
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