Levamisole and skin disease

A single-group trial of end-stage patients with anthroponotic cutaneous leishmaniasis: Levamisole in combination with Glucantime in field and laboratory models

Currently, there is no satisfactory treatment modality available for cutaneous leishmaniasis (CL). The major objective of the present study was to explore the effect of immunomodulator-levamisole in combination with Glucantime in end-stage unresponsive patients with anthroponotic CL (ACL). Twenty end-stage unresponsive patients with ACL were identified for participation in this single-group trial study. Simultaneously, each patient was received a combination of levamisole pills along with Glucantime during the remedy course. Several in vitro complementary experiments were performed to evaluate the mode of action of levamisole and Glucantime alone and in combination using a macrophage model, in vitro MTT assay, flow cytometry and quantitative real time PCR (qPCR). Overall, 75% of the patients showed complete clinical cure, 10% partially improved and the remaining (15%) had underlying chronic diseases demonstrated no response to the treatment regimen. In in vitro studies, there was no cytotoxic effect associated with these drugs in the range of our experiments. The findings by the flow cytometric analysis represented that the highest apoptotic values corresponded to the drugs combination (32.23%) at 200 μg/ml concentration. Finally, the gene expression level of IL-12 p40, iNOS and TNF-α promoted while the level of IL-10 and TGF-β genes reduced as anticipated. The findings clearly indicated that the combination of levamisole and Glucantime should be considered in end-stage unresponsive patients with ACL who have not responded to basic treatments. The immunomodulatory role of levamisole in mounting immune system as documented by the in vitro experiments and further substantiated by this single-group trail study was highlighted.

Second-line treatment in seronegative spondylarthropathies

The literature concerning second-line treatment of seronegative spondylarethropathies from 1940 to August 1993 was reviewed. Sulfasalazine appeared to be effective in the treatment of ankylosing spondylitis (AS) and promising in reactive arthritis (ReA) and Reiters' syndrome (RS). Methotrexate and azathioprine were associated with a remarkable improvement in some cases of AS and RS. Methylprednisolone and levamisole were both efficacious in AS, but levamisole was associated with occasional severe side effects. Radiation therapy led to short-term improvement in AS, but was abandoned because of severe long-term side effects. Only sulfasalazine has been studied in sufficient detail to allow definitive conclusions, but methotrexate and azathioprine may be promising drugs.

Low molecular weight immunopotentiators

It has long been recognized that modulation of the immune system by various agents may have potential for the management of certain infectious and neoplastic diseases. Both natural products as well as chemically synthesized compounds have been investigated for immunotherapeutic potential. Over the years, conflicting reports on the clinical efficacy of these agents have left the early promise of immunotherapy unfulfilled. However, the manipulation of the immune system to generate a desired effect is becoming feasible as the mechanisms which regulate the immune network are better understood. Much of the early work on immunotherapy concentrated on the development of immunopotentiators, agents which enhance the host's own immune system against cancer cells or infectious pathogens. Furthermore, with the development of subunit and/or synthetic vaccines, which are often weakly immunogenic, the importance of developing agents capable of acting as adjuvants became apparent. As a result, the utility of immunopotentiators has now extended to the area of vaccines. There are a number of reviews available on immunomodulators [see Fenichel, R. L. and Chirigos, M. A. (eds) (1984), Immune Modulation Agents and Their Mechanisms, Marcel Dekker, New York]. The purpose of this article is to provide an update on low molecular weight agents capable of potentiating the immunological network. Attention will be given to those agents which have undergone significant clinical development in the areas of cancer, infectious diseases and vaccination over the past several years. These agents will be categorized as to whether they are naturally occurring or chemically synthesized.

Controlled therapeutic trial of levamisole and sulphasalazine in acute ulcerative colitis

Forty five patients with acute ulcerative colitis were randomly allocated to receive (a) sulphasalazine, (b) levamisole, or (c) a combination of sulphasalazine and levamisole. Each group contained 15 patients. The ulcerative colitis activity index (UCAI), the remission and relapse rates were compared at three monthly intervals for one year. The UCAI fell in each group. Detailed analysis of all clinical and biochemical parameters used for estimation of UCAI showed that the only difference was in patients receiving combined therapy who continued to have a raised ESR and platelet count. Fewer patients, however, went into remission on levamisole therapy (46.6%) compared with the other two groups (66.6%). The cumulative relapse rate was 20% for those receiving levamisole compared with 6.6% in the other groups. Side effects were observed in 20% of patients receiving levamisole, 26% receiving sulphasalazine, and 40% in those having combined therapy. The results indicate that levamisole is unlikely to have a major role in the management of patients with ulcerative colitis.

Levamisole in patients with recurrent herpes infection

The effect of the immunomodulating drug levamisole was tested in 33 patients with frequently recurring attacks of herpes labialis or herpes genitalis. All patients had suffered monthly recurrent attacks for at least six months, but were otherwise healthy. Patients were randomly allocated to receive levamisole tablets, 2.5 mg/kg orally, on two consecutive days each week for 26 weeks, or placebo tablets taken for a similar time. The tablets were reversed for a second consecutive six-month period. Seven of 21 patients (33%) with recurrent herpes genitalis infection showed complete response and 10 (47%) showed a partial response while receiving levamisole. Three of 21 patients (14%) showed a partial response on placebo. Six of 12 patients (50%) with herpes labialis showed complete or partial responses, with three partial responses on placebo. Frequent minor drug side effects were seen, and therapy was ceased in one patient. No episodes of leucopenia or agranulocytosis were encountered. Levamisole produces a significantly better reduction in frequency, duration and severity of herpes attacks than placebo, particularly after the initial eight weeks of administration.

Treatment of multiple viral warts with levamisole

Seventy-seven patients with multiple common warts were screened for a double-blind study using levamisole. Of these, only 32 patients showed cellular immune deficiency. Fourteen patients received 2.5 mg/kg, two days a week, for eight weeks, and eighteen received a placebo. Both groups showed some improvement but results were not statistically different. Placebo plays a significant role in the treatment of warts.