03264nas a2200325   4500000000100000008004100001260001200042653001100054653002800065653002900093653002600122653001600148653001600164100001000180700001400190700001400204700002200218700001600240700001800256700001300274700001200287700001200299700001200311700001700323245008900340856006300429300001100492520242100503022001402924       2026                            d  c09/202610aAzoles10aCutaneous leishmaniasis10aLiposomal amphotericin B10aMeglumine Antimoniate10aMiltefosine10apentamidine1 aEgg M1 aWienand D1 aHarpain L1 aBrunner-Kovarik M1 aWalochnik J1 aWiesmueller M1 aHampel A1 aSpath T1 aTrnka L1 aSimon J1 aHandisurya A00aSystemic treatment of cutaneous leishmaniasis: A systematic review and meta-analysis  uhttps://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.70711  a1 - 133 a<p><strong>BACKGROUND: </strong></p>

<p>Cutaneous leishmaniasis (CL) is increasingly reported in previously non-endemic European countries. Although often self-limiting or amenable to topical therapy, systemic treatment is indicated in specific situations. Evidence guiding systemic therapies remains limited and heterogeneous.</p>

<p><strong>OBJECTIVES: </strong></p>

<p>This systematic review and meta-analysis aimed to synthesize available evidence on systemic treatment regimens for CL.</p>

<p><strong>METHODS: </strong></p>

<p>MEDLINE/PubMed and Embase were searched for clinically and/or parasitologically confirmed CL receiving systemic monotherapy with meglumine antimoniate (MA), miltefosine, azoles, pentamidine, or liposomal amphotericin B (L-AmB) until February 2026. Primary outcome was clinical cure assessed 2-7.5 months after treatment initiation. Pooled cure rates were estimated using random-effects meta-analysis. Subgroup analyses were performed for Old World (OWCL) and New World (NWCL) CL, and by Leishmania species.</p>

<p><strong>RESULTS: </strong></p>

<p>Eighty-three studies comprising 96 treatment arms and 4603 patients with OWCL and NWCL were included. Overall, study quality was moderate (per JBI checklist). MA, long regarded as standard of care in many countries, had a pooled cure rate of 59% (95% CI 52%-66%). Higher rates were observed with L-AmB (77%; 95% CI 56%-90%), followed by miltefosine (75%; 95% CI 69%-81%), itraconazole (70%; 95% CI 65%-76%), and fluconazole (62%; 95% CI 16%-93%). Lower rates were obtained with pentamidine (55%; 95% CI 42%-67%) and ketoconazole (36%; 95% CI 7%-82%). Species- and region-specific sub-analyses indicated miltefosine highly effective for OWCL (particularly L. major) and NWCL (L. braziliensis, L. guyanensis, L. panamensis). Head-to-head comparisons of miltefosine and MA showed no statistically significant difference. L-AmB was similarly effective in NWCL (particularly L. braziliensis), with lack of evidence for other species.</p>

<p><strong>CONCLUSIONS: </strong></p>

<p>Systemic treatment options for CL show variable efficacy. Despite the promising cure rates for miltefosine and L-AmB, comparative evidence remains insufficient to support therapy recommendations. Confirmation in adequately powered, high-quality RCTs, ideally stratified by species, is warranted to strengthen the evidence base.</p>
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