[Leish-l] FW: FW: Single-Dose Therapy for Visceral Leishmaniasis

[jeffrey shaw]

Date: Fri, 12 Feb 2010 22:09:54 -0800
From: aranjan30 at yahoo.com
Subject: Re: [Leish-l] FW:  Single-Dose Therapy for Visceral Leishmaniasis
To: jayusp at hotmail.com



Dear All,
This should be considered as a landmark in the field of anti-leishmanial trial - certainly going to be proved as a boon for the poor patients in Indian Sub-continent where the cost of VL treatment is very high and beyond reach of the general mass. In context of the public health benefits, this has immense potential to reduce the economic burden both at micro as well as macro level. 
Alok Ranjan,
Scientist 'C',
Division of Epidemiology and Biostatistics,
RMRIMS, ICMR, Patna, India.




From: jeffrey shaw <jayusp at hotmail.com>
To: Leish-L <leish-l at lineu.icb.usp.br>
Sent: Fri, February 12, 2010 4:08:10 PM
Subject: [Leish-l] FW: Single-Dose Therapy for Visceral Leishmaniasis






Date: Thu, 11 Feb 2010 22:58:51 -0800
From: s_bashaye at yahoo.com
Subject: Re: [Leish-l] Single-Dose Therapy for Visceral Leishmaniasis
To: jayusp at hotmail.com; leish-l at lineu.icb.usp.br





Dear all,
 

It is good news to Developing countries like Ethiopia. We opt for short course therapies in that it minimizes time for admission which is related again to many interrelated costs, Problems related to treatment cost should of course be. Is there a need of conducting related trial in Africa including Ethiopia?
Seife Bashaye,
RTI /PMI, Ethiopia




From: jeffrey shaw <jayusp at hotmail.com>
To: Leish-L <leish-l at lineu.icb.usp.br>
Sent: Thu, February 11, 2010 8:07:55 AM
Subject: [Leish-l] Single-Dose Therapy for Visceral Leishmaniasis




Summary and Comment
Single-Dose Therapy for Visceral Leishmaniasis
A single infusion of liposomal amphotericin B was not inferior to a 15-dose regimen of amphotericin B deoxycholate.
Despite impressive cure rates for several antileishmanial agents, lengthy treatment courses limit the appeal of these therapies. In recent clinical trials, high cure rates have been seen with a 5-day course of liposomal amphotericin B. This finding, coupled with a price reduction for this antimicrobial in developing countries, prompted evaluation of even shorter courses of therapy.
In an open-label trial, 410 patients with visceral leishmaniasis, or kala-azar, were randomized to receive a single infusion of liposomal amphotericin B (10 mg/kg) or 15 alternate-day infusions of amphotericin B deoxycholate (1 mg/kg; conventional therapy). The trial was conducted in northeastern India, which is home to approximately 50% of such patients worldwide. Participants — aged 2 to 65 years — were evaluated at 30 days postenrollment for apparent cure (i.e., absence of fever, clinical improvement, reduction in
 spleen size, and a splenic-aspirate score of 0) and then at 6 months for cure (being healthy, with no signs or symptoms of relapse).
All 304 patients in the liposomal-therapy group and 106 (98%) of 108 in the conventional-therapy group had apparent cure at 30 days postenrollment. At 6 months, cure rates were similar between groups: 95.7% (95% confidence interval, 93.4%–97.9%) and 96.3% (95% CI, 92.6%–99.9%), respectively. No serious adverse events were reported in either group. The estimated treatment costs were higher for amphotericin B deoxycholate than for liposomal amphotericin B (US$436 vs. $162).
Comment: The availability of a new preferential price agreement for liposomal amphotericin B in developing countries was key in the decision to conduct this trial. The results are impressive and should prompt a reevaluation of current treatment strategies for kala-azar.
— Larry M. Baddour, MD
Published in Journal Watch Infectious Diseases February 10, 2010

Citation(s):
Sundar S et al. Single-dose liposomal amphotericin B for visceral leishmaniasis in India. N Engl J Med 2010 Feb 11; 362:504.

 		 	   		  
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