Liposomal amphotericin B for complicated visceral leishmaniasis (kala-azar) in eastern Sudan: how effective is treatment for this neglected disease?
Article first published online: 17 JAN 2014
© 2014 John Wiley & Sons Ltd
Tropical Medicine & International Health
Volume 19, Issue 2, pages 146–152, February 2014
How to Cite
Salih, N. A., van Griensven, J., Chappuis, F., Antierens, A., Mumina, A., Hammam, O., Boulle, P., Alirol, E., Alnour, M., Elhag, M. S., Manzi, M., Kizito, W. and Zachariah, R. (2014), Liposomal amphotericin B for complicated visceral leishmaniasis (kala-azar) in eastern Sudan: how effective is treatment for this neglected disease?. Tropical Medicine & International Health, 19: 146–152. doi: 10.1111/tmi.12238
- Issue published online: 20 JAN 2014
- Article first published online: 17 JAN 2014
- Centre for Operational Research
- International Union Against Tuberculosis and Lung Disease
- Operational Research Unit
- Médecins sans Frontieres
- Institute for Tropical Medicine
- amphotericin B;
- operational research
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.
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.
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.
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.