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Home > Research and development > Portfolio

Cutaneous leishmaniasis 

Miltefosine + thermotherapy for cutaneous leishmaniasis

Home > Research and development > Portfolio

Cutaneous leishmaniasis

Miltefosine + thermotherapy for cutaneous leishmaniasis

objective

Explore whether existing approved treatment approaches for cutaneous leishmaniasis are more effective when used in combination

project start
2015

current phase of drug development

Discovery project phase
Drug Discovery
Translation project phase
Translational research
clinical trials icon
Clinical trials
Treatment Access
Registration & access

updated 21 Feb 2025

When administered alone, the safety and efficacy profiles of current cutaneous leishmaniasis treatments (antimonials, miltefosine, and thermotherapy) are well established. For people with uncomplicated cutaneous leishmaniasis, where lesions are small in number and size and are not located on the face or on joints, thermotherapy – applying heat to the wound for a short duration – is the most practical and effective treatment option.

Using a combination of therapeutic approaches may improve efficacy rates, shorten treatment duration, and reduce the rate of adverse events. The Phase II study found that a combination of thermotherapy with a shorter course of oral miltefosine achieves significantly better results than thermotherapy alone. Next, a Phase III study will assess the combination treatment for non-inferiority against current recommended treatments.

Project updates

2024

Enrolment in the Phase III study was completed, with 127 participants included: 64 in the miltefosine monotherapy arm, and 63 in the miltefosine + thermotherapy arm. Patient demographics and baseline characteristics were similar across both treatment arms. Most adverse events reported were mild and aligned with the expected safety profile of the study interventions. The combination arm was shown to be non-inferior to standard miltefosine monotherapy in the per-protocol analysis at day 90 (65.5% vs. 75.0%, respectively). However, the combination treatment appears to be more efficacious than miltefosine alone for lesions due to L. braziliensis.

2023

The last patient in the Phase III study was enrolled in August. A total of 182 patients were enrolled, including 63 in the miltefosine monotherapy arm, 63 in the combination thermotherapy and miltefosine arm, and 56 in the meglumine antimoniate arm prior to its removal from the protocol. A new protocol amendment was made to address WHO recommendations for the prevention, early detection, and management of ocular adverse events in patients exposed to miltefosine and submitted to all ethics committees in early March.

2022

To align with the new treatment guidelines adopted by the World Health Organization and Pan American Health Organization in July 2022, and as requested by local investigators, the study protocol was amended to remove the arm of the study using antimonial therapy. This is in line with DNDi’s position promoting therapies that are less toxic and easier to administer in field settings. The enrolment of patients continued throughout the year and is expected to be completed in the second quarter of 2023.   

2021

The Phase III trial was initiated at four of the five study sites in 2021 with 67 patients enrolled, and no serious adverse events were recorded during the year. Approval to initiate the trial at the study site in Bolivia has been obtained with the study initiation visit planned for the first quarter of 2022. New waves of COVID-19, related travel restrictions, and the decision to prioritize the medical treatment of people with COVID-19 have proven challenging, particularly with regard to the recruitment of study participants.    

2020

Preparations for a Phase III trial at five study sites in Bolivia, Brazil, Panama, and Peru continued, although enrolment of the first patients was delayed slightly due to the COVID-19 pandemic. Patient enrolment at all five study sites is expected to begin during the first half of 2021.

2019

Preliminary results of a Phase II study completed in April 2019 show the combination of thermotherapy with a shorter course of oral miltefosine to be significantly better than thermotherapy alone for the treatment of uncomplicated cutaneous leishmaniasis in the Americas. A Phase III study is planned to start in the second half of 2020 to compare the non-inferiority of the combination against the current recommended systemic treatments, sodium stibogluconate or miltefosine.

2018

Recruitment of patients was completed in Peru (65 patients) and in Colombia (65 patients). The last patient six-month follow-up is expected in early 2019. Interim results supported the preparation of a Phase III study in the Americas comparing the combination therapy (thermotherapy and miltefosine) against the standard treatment (meglumine antimoniate) which comes with risks of potential toxicity. The study is being planned in four countries in Latin America.

2017

Recruitment of patients continued in Peru with the inclusion of 41 patients, and started in Colombia with the inclusion of 21 patients (out of 130 patients in total). An interim analysis is planned in early 2018 once 65 patients have completed the day 90 follow-up visit.

2016

At the end of 2016, official approvals were obtained, a site initiation visit conducted and the first patients were enrolled in Peru, while final approvals are expected by early 2017 for a second site in Colombia.

News & resources

  • 7 March 2022 – A phase II multicenter randomized study to evaluate the safety and efficacy of combining thermotherapy and a short course of miltefosine for the treatment of uncomplicated cutaneous leishmaniasis in the New World, PLOS Neglected Tropical Diseases

Clinical trials documents

Partners

  • FUNDERMA – Fundación Nacional de Dermatología, Bolivia
  • Fiotec, Brazil
  • Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama
  • Instituto René Rachou (IRR) – Fiocruz Minas, Brazil
  • Programa Nacional de Leishmaniasis Colombia, Colombia
  • Thermosurgery Technologies Inc., USA
  • Universidad Peruana Cayetano Heredia, Peru
  • Universidad de Antioquia Medellin, Programa de Estudio y Control de Enfermedades Tropicales, Colombia
  • Universidade Federal da Bahia (UFBA), Brazil
  • Universidade Federal de Mato Grosso (UFMT), Brazil
  • Vice-Presidência de Pesquisa e Coleções Biológicas – VPPCB, Brazil
  • Zürcher Hochschule für Angewandte Wissenschaften, Switzerland
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  • Fiotec
  • ,Brazil
  • FUNDERMA – Fundación Nacional de Dermatología
  • ,Bolivia
  • Instituto Conmemorativo Gorgas de Estudios de la Salud
  • ,Panama
  • Instituto René Rachou (IRR) – Fiocruz Minas
  • ,Brazil
  • Programa Nacional de Leishmaniasis Colombia
  • ,Colombia
  • Thermosurgery Technologies Inc.
  • ,USA
  • Universidad de Antioquia Medellin, Programa de Estudio y Control de Enfermedades Tropicales
  • ,Colombia
  • Universidad Peruana Cayetano Heredia
  • ,Peru
  • Universidade Federal da Bahia (UFBA)
  • ,Brazil
  • Universidade Federal de Mato Grosso (UFMT)
  • ,Brazil
  • Vice-Presidência de Pesquisa e Coleções Biológicas – VPPCB
  • ,Brazil
  • Zürcher Hochschule für Angewandte Wissenschaften
  • ,Switzerland
  • Universidad de Antioquia Medellin, Programa de Estudio y Control de Enfermedades Tropicales, Colombia
  • Programa Nacional de Leishmaniasis Colombia, Colombia
  • Thermosurgery Technologies Inc., USA
  • Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama
  • Zürcher Hochschule für Angewandte Wissenschaften, Switzerland
  • Fiotec, Brazil
  • FUNDERMA – Fundación Nacional de Dermatología, Bolivia
  • Vice-Presidência de Pesquisa e Coleções Biológicas – VPPCB, Brazil
  • Universidad Peruana Cayetano Heredia, Peru
  • Universidade Federal da Bahia (UFBA), Brazil
  • Universidade Federal de Mato Grosso (UFMT), Brazil
  • Instituto René Rachou (IRR) – Fiocruz Minas, Brazil

Funding

  • Germany - Federal Ministry of Education and Research (BMBF) through KfW
  • Switzerland - Swiss Agency for Development and Cooperation (SDC)
  • The Netherlands - Dutch Ministry of Foreign Affairs (DGIS)
  • UK - UK International Development
​
  • Médecins Sans Frontières International
  • Other private foundations and individuals
​

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