ClinicalTrials.gg
CompletedNCT04515186Updated May 8, 2025

Combination, Miltefosine Monotherapy for Cutaneous Leishmaniasis in New World

A Phase 3 interventional study of Meglumine Antimoniate and Miltefosine in Cutaneous Leishmaniases, sponsored by Drugs for Neglected Diseases. Completed at 6 sites in 4 countries. Open to participants aged 12 Years to 60 Years. Per ClinicalTrials.gov, last updated 2025-05-08.

Sponsored by Drugs for Neglected Diseases · Phase 3, Interventional, and Treatment

From the registry’s dates

  • Primary completion was Nov 2023, 3 years ago, and no results have been posted to the registry.
Phase
Phase 3
Study type
Interventional
Enrollment
184
Allocation
Randomized
Ages
12 Years to 60 Years
Sex
All
01

Study summary

This study evaluates if the combination of thermotherapy (one application, 50⁰C for 30") and 3 weeks of miltefosine is safe and have a comparable cure rate with the current recommended first line treatments comprising meglumine antimoniate for 3 weeks for the treatment of uncomplicated cutaneous leishmaniasis cases in the New World.

Read the detailed description

This randomized, open label, multi-centre, non-inferiority study aims to compare that the combination of thermotherapy (one application, 50⁰C for 30") and 3 weeks of miltefosine (2.5 mg/kg/day for 21 days orally) (here after referred to as combination), is non-inferior to the current recommended first line treatment miltefosine monotherapy (2.5 mg/kg/day for 28 days orally), for uncomplicated CL cases in the New World.

Originally, the study was planned to assess the non-inferiority of the combination therapy in comparison to the current recommended first line treatments, meglumine antimoniate or miltefosine monotherapy for 28 days. However, based on the revised treatment guidelines published by WHO-PAHO in 2022 in which the use of systemic antimonial received only a conditional recommendation, principally because of its well-known toxicity, and is recommended to be used only in case where there is no other option, the study protocol amendment 7 was proposed to prematurely discontinue the inclusion of additional patients in the meglumine antimoniate arm.

Primary Objective

  • To determine the non-inferior efficacy of the combination in comparison to the standard first line treatment miltefosine monotherapy as measured by the percentage of patients with initial clinical cure at Day 90.

Secondary objectives

  • Assess the proportion of patients who show clinical improvement at D90 (have more or equal of 75% and less than 100% re-epithelization) and achieve 100% re-epithelization at D105 (late responders).
  • Assess the proportion of relapses at D180.
  • Describe the proportion of patients randomized in the meglumine antimoniate arm until its discontinuation who show initial cure at D90, clinical improvement at D90 and 100% re-epithelization at D105 and relapse at D180.
  • Assess the safety and tolerability profile for each regimen (percentage of treatment discontinuation, frequency and severity, causality with each study drug and seriousness of Adverse Events (AEs)).
  • Assess the time to achieve 100% re-epithelialization/ flattening of ulcerated/ non ulcerated lesions by Leishmania species.

A computer-generated randomization code will be used for patient treatment allocation to one of the three arms indicated and utilizing a 1:1:1 allocation ratio.

Patients assigned to the combination treatment will start treatment at Day 1 and have a follow-up visit on 24 hours to assess safety of thermotherapy. Hereafter, these patients are required to return at Days 7, 14, 21, 45, 63, 90, 105 (late responders only) and 180 after the beginning of treatment to assess safety and efficacy.In Brazil, women of childbearing potential are required to also return on D120 and D150 to perform blood pregnancy tests. Women with irregular menstrual cycle, should return for blood pregnancy tests every two weeks until D150.

Patients assigned to the meglumine antimoniate treatment before discontinuation of this arm becomes effective arerequired to come at Days 1, 7, 14, 21, 45, 63, 90, 105 (late responders only) and 180 after the beginning of treatment to assess safety and efficacy.

Patients assigned to the miltefosine monotherapy are required to come at Days 1, 7, 14, 21, 28, 45, 63, 90, 105 (late responders only) and 180 after the beginning of treatment to assess safety and efficacy. In Brazil, women of childbearing potential are required to also return on D120 and D150 to perform blood pregnancy tests. Women with irregular menstrual cycle, should return for blood pregnancy tests every two weeks until D150.

Patients who have 100% re-epithelization at D90 are declared cured and appointed to come to their D180 assessment. If at D90 re-epithelization of the ulcer(s) is more or equal to 75% but less than 100%, patients will be defined as having clinical improvement and will be asked to return to D105 for a late responder assessment.

02

Conditions studied

  • Cutaneous Leishmaniases
03

In context

Leishmaniasis, Cutaneous

103 studies on the registry are indexed under Leishmaniasis, Cutaneous; 18 are open to participants now.

This study's enrollment of 184 is above the median of 60 across 77 interventional studies indexed under Leishmaniasis, Cutaneous.

Browse Leishmaniasis, Cutaneous studies →

Lead sponsor

Drugs for Neglected Diseases is the lead sponsor of 58 studies on the registry; 3 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
12 Years to 60 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Males and females, aged ≥12 and ≤60 years old (upper age limit according to local regulations), and weighing ≥ 30Kg.
  • Patient with a confirmed diagnosis of CL in at least one lesion by at least one of the following methods: 1) microscopic identification of amastigotes in stained lesion tissue, or 2) demonstration of Leishmania by Polymerase Chain Reaction (PCR), or 3) positive culture for promastigotes.
  • Patient has a lesion that satisfies the following criteria:

    • Lesion size ≥ 0.5 cm and ≤ 4 cm (longest diameter).
    • not located on the ear, face, close to mucosal membranes, or on a location that in the opinion of the Principal Investigator (PI) is difficult to apply the TT.
    • Patient with ≤ 4 CL lesions.
    • Duration of lesion less than 4 months by patient history.
  • Patient able to give written / assent form.
  • In the opinion of the investigator, the patient is capable of understanding and complying with the protocol.

Exclusion criteria

Exclusion Criteria:

  • Female with a positive urine or blood pregnancy test at screening or who is breast feeding or female at fertile age who does not agree to take appropriate effective during treatment period and up to D180 visit. In Brazil: female at fertile age who does not agree to use two effective methods of contraception: one barrier method and one highly effective method (defined in section 8.2.4) 30 days prior to the treatment onset and up to D180 visit.
  • History of medical problems / treatment that might interact, either negatively or positively, with treatment of cutaneous leishmaniasis including any immunocompromising condition.
  • Within 8 weeks (56 days) of Day 1, received treatment for the entry lesion leishmaniasis with any medication including antimonials likely, in the opinion of the PI, to modify the course of the Leishmania infection.
  • Has diagnosis or suspected diagnosis of mucocutaneous leishmaniasis based on physical exam.
  • Has laboratory values at screening as follows:

    • Serum creatinine: above upper normal level*.
    • (ALT) or Aspartate aminotransferase (AST): 3 times above upper normal level*.

      • Normal ranges obtained from local laboratory.
  • Patient who is not willing to attend the study visits or is not able to comply with follow-up visits up to 6 months.
  • Known history of addiction/ alcohol abuse.
  • to miltefosine or any study medication .
  • Patients with Sjogren-Larson Syndrome.
Terms in these criteria, in plain language(6)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
184 participants (actual)

Study arms

  • Other
    Meglumine Antimoniate

    Meglumine Antimoniate, 20 mg/kg/day for 20 days parenterally. This trial arm was discontinued after protocol amendment 7. However, patients assigned to this arm before protocol amendment 7 becomes effective will continue in the study and will receive complete treatment as initially planned.

    Drug: Meglumine Antimoniate

  • Active comparator
    Miltefosine monotherapy

    Miltefosine monotherapy 2.5 mg/kg/day for 28 days orally

    Drug: Miltefosine

  • Experimental
    Thermotherapy + miltefosine

    Thermotherapy (one session, 50⁰C for 30" applications\*) + miltefosine 2.5 mg/kg/day for 21 days orally.

    Drug: Miltefosine · Device: Thermotherapy machine

Interventions

  • Vials of a 5mL solution. Each vial contains 405 mg of Sb5+ corresponding to 8.1% Sb5+ (81 mg/mL).

    Also known as: Glucantime®

  • 50 mg capsule

    Also known as: Impavido®

  • DeviceThermotherapy machine

    Localized Current Field radio-frequency generating device

    Also known as: ThermoMed™

06

What researchers measure

Primary outcomes

  1. The proportion of initial clinical cure in each arm.

    Defined for ulcerated lesions as 100% re-epithelialization of the ulcer(s) on D90 as compared to D1 and for non-ulcerated lesions as flattening and/or no signs of induration of the lesion(s) on D90 as compared to D1.

    Time frame: Day 90

Secondary outcomes

  1. The number of patients who fulfil the criteria for clinical improvement at D90 and late responders at D105.

    Clinical improvement is defined for ulcerated lesions as more than or equal to 75% but less than 100% re-epithelization of the ulcer(s) as compared to D1, and for non-ulcerated lesions as more than or equal to 75% but less than 100% of flattening and/ or signs of induration of the lesion(s) as compared to D1. Late responders isdefined for ulcerated lesions as 100% re-epithelialization of the ulcer(s) on D105 compared to D1, and for non-ulcerated lesions as 100% of flattening and/or no signs of induration of the lesion(s) on D105 as compared to D1.

    Time frame: Days 90 and 105

  2. The number of patients who fulfil the criteria of initial cure at D90 or late responders at D105 and have no relapse by D180 (final cure).

    Time frame: Day 180

  3. Percentage of treatment discontinuation, frequency, severity, causality with each study drug and seriousness of AEs by treatment group.

    Time frame: Through study completion, i.e up to 6 months

  4. Proportion of lesions with 100% re-epithelialization/flattening at each measurement time point by Leishmania sp.

    Time frame: Days 7, 14 and 21. At end of treatment (days 21 or 28), and at days 45, 63, 90, 105 and 180.

  5. The number of patients randomized in the meglumine antimoniate arm until its discontinuation who fulfill the criteria of initial cure at D90 or late responders at D105 and have no relapse by D180 (final cure).

    Time frame: Day 180

07

Study locations

6 sites
  • Fundación Nacional de Dermatología
    Santa Cruz de la Sierra, Bolivia
  • Instituto René Rachou Oswaldo Cruz Foundation- FIOCRUZ MINAS
    Belo Horizonte, MG, Brazil
  • Julio Muller University Hospital Federal University of Mato Grosso
    Cuiaba, Brazil
  • Federal University of Bahia Immunology Department
    Salvador, Brazil
  • Instituto Conmemorativo Gorgas de Estudios de la Salud
    Panama, Panama
  • Universidad Peruana Cayetano Heredia
    Lima, Peru
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Jan 2021 to primary completion in Nov 2023, 33 months.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 13, 2020
First posted
Aug 17, 2020
StartActual
Jan 26, 2021
Primary completionActual
Nov 10, 2023
CompletionActual
Feb 27, 2024
Last update
May 8, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 8, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04515186
Lead sponsor
Drugs for Neglected Diseases
Responsible party
Sponsor
First posted
Aug 17, 2020
Start date
Jan 26, 2021
Primary completion
Nov 10, 2023
Completion
Feb 27, 2024
Last update
May 8, 2025

Study contacts

Paulo Machado
principal investigator · Federal University of Bahia
Marcia Hueb
principal investigator · Julio Muller University Hospital Federal University of Mato Grosso
Fiorela Yuly Alvarez Romero
principal investigator · Universidad Peruana Cayetano Heredia
Juan Miguel Pascale
principal investigator · Instituto Conmemorativo Gorgas de Estudios de la Salud
Jaime Soto
principal investigator · Fundación Nacional de Dermatología
Glaucia Cota
principal investigator · Instituto René Rachou Oswaldo Cruz Foundation- FIOCRUZ MINAS

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Feb 2024. You cannot join it, but the record below documents what was studied.

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Studies of the drug tested here: Miltefosine

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