Liposomal amphotericin B for complicated visceral leishmaniasis (kala‐azar) in eastern Sudan: how effective is treatment for this neglected disease?. Issue 2 (17th January 2014)

• Record Type: Journal Article
• Authors: Salih, Niven A.; van, Johan; Chappuis, François; Antierens, Annick; Mumina, Ann; Hammam, Omar; Boulle, Philippa; Alirol, Emilie; Alnour, Mubarak; Elhag, Mousab S.; Manzi, Marcel; Kizito, Walter; Zachariah, Rony
• Is Part Of: Tropical medicine & international health. Volume 19:Issue 2(2014:Feb.)
• Page Start: 146
• Page End: 152
• Publication Date: 2014-01-17
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12238
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12238-abs-0001"> <title>Abstract</title> <sec id="tmi12238-sec-0001" sec-type="section"> <title>Objectives</title> <p>The aim of this study was to report the patient profile and treatment outcomes, including relapses, of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (AmBisome) in Gedaref, Sudan.</p> </sec> <sec id="tmi12238-sec-0002" sec-type="section"> <title>Methods</title> <p>AmBisome was offered to two groups of patients: primary VL patients with specific criteria (age ≤2 or ≥45 years, advanced clinical disease, pregnancy, HIV co‐infection and contraindications for antimonials) and VL relapses. AmBisome was given at a total dose of 30 mg/kg, over 10 days. Slow responders received up to 50 mg/kg. Treatment failure was confirmed parasitologically. Standardised treatment outcomes were assessed.</p> </sec> <sec id="tmi12238-sec-0003" sec-type="section"> <title>Results</title> <p>Between March 2010 and June 2012, a total of 281 (74%) patients with primary VL and 98 (26%) patients with VL relapses received AmBisome (54% male, median age = 11 years, interquartile range 2–30). End‐of‐treatment outcomes for primary VL were 260 (92%) initial cure including three (1%) slow responders, three (1%) treatment failures, 14 (5%) deaths and four (1%) unknown outcomes. Outcomes for VL relapses were 92 (94%) initial cure with five (5%) slow responders, four (4%) treatment failures, one (1%) death and one (1%) unknown outcome. At 6 months, there were 19 (7%) relapses amongst primary VL and 10 (10%) VL relapses had a new relapse. Loss to follow‐up in both groups was 38%. None of the deaths that occurred during the study period was attributed to AmBisome.</p> </sec> <sec id="tmi12238-sec-0004" sec-type="section"> <title>Conclusion</title> <p>AmBisome appears to be effective for initial cure of VL and the drug seems safe, but is expensive (400 USD/treatment). Sustained mechanisms to allow improved access of this expensive drug particularly in East Africa are urgently needed. Relapses and losses to follow‐up require specific investigation.</p> </sec> </abstract>