Retrospective study on the outcome of treatment with miltefosine for canine Leishmaniasis in veterinary first-line practice.

Abstract

Canine Leishmaniasis is a vector-borne disease caused by the intracellular protozoa Leishmania infantum, which continues to be a difficult and challenging disease to effectively treat and cure. Among variable antileishmanial drugs, the use of miltefosine appeared to be safe and effective for treatment of canine Leishmaniasis and is nowadays widely used in veterinary medicine. This study was aimed to evaluate the use of miltefosine in Dutch veterinary first-line practice, a non-endemic country, by assessing survival, efficacy of a first miltefosine therapy cycle as measured by recovery of clinical signs and clinicopathological parameters, and side effects as outcome parameters. Patient files of dogs with a confirmed diagnosis and treated with miltefosine in 2014, 2015, 2016 and 2017, were retrospectively reviewed. Survival analysis and assessment of side effect was performed on the complete dataset (n=53), while the efficacy of therapy was assessed only on a subset (n=25) of included dogs (“Inclusion T0-T1”). A survival probability of 78% and 71%, three-years from diagnosis and commencement of the first miltefosine therapy cycle, respectively, was shown. Gastrointestinal side effects were reported in 23% of treatments. For the efficacy of the first miltefosine therapy cycle, the clinical signs lymphadenomegaly and scaling skin, and the laboratory parameters hematocrit, thrombocytes, total protein, globulins, albumin, and A/G-ratio improved significantly after treatment. Administration of allopurinol was very common and may have had a positive effect on the outcome. This study provides an accurate overview of the use of miltefosine in Dutch veterinary first-line practice and therewith provided useful and promising results.