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Review
. 2012 Dec;17(4):493-510.
doi: 10.1517/14728214.2012.748036. Epub 2012 Nov 20.

Liposomal amphotericin B as a treatment for human leishmaniasis

Manica Balasegaram  1 , Koert Ritmeijer, Maria Angeles Lima, Sakib Burza, Gemma Ortiz Genovese, Barbara Milani, Sara Gaspani, Julien Potet, François Chappuis
Affiliations
Free PMC article
Review

Liposomal amphotericin B as a treatment for human leishmaniasis

Manica Balasegaram et al. Expert Opin Emerg Drugs. 2012 Dec.
Free PMC article

Abstract

Introduction: Leishmaniasis is a parasitic disease transmitted by phlebotomine sandflies. Between 700,000 and 1.2 million cases of cutaneous leishmaniasis and between 200,000 and 400,000 cases of visceral leishmaniasis (VL), which is fatal if left untreated, occur annually worldwide. Liposomal amphotericin B (LAMB), alone or in combination with other drugs, has been extensively studied as VL treatment, but data on routine field use are limited, and several challenges to patients' access to this life-saving drug remain.

Areas covered: This article provides a review of clinical studies on LAMB for VL and other forms of leishmaniasis. The current development of generic versions of LAMB and related challenges are also discussed.

Expert opinion: LAMB proved to be highly efficacious and safe in over 8000 VL patients treated by MÉdecins Sans Frontières in South Asia, and its use was feasible even at primary healthcare level. Despite requiring higher doses, LAMB is the drug of choice to treat vulnerable groups (e.g., pregnant or HIV positive) and relapsing VL patients in East Africa. LAMB should be included in national VL guidelines and registered in all VL endemic countries. Its cost should be further reduced and regulatory pathways to prove bioequivalence for generic LAMB products should be implemented.

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Figures

Figure 1.
Figure 1.
Young female patient with visceral leishmaniasis receiving liposomal amphotericin B infusion at Vaishali District Hospital, Bihar State, India.
Figure 2.
Figure 2.
Nursing chart showing rapid clearance of fever after initiation of liposomal amphotericin B treatment in a patient with visceral leishmaniasis at Vaishali District Hospital, Bihar State, India.
See this image and copyright information in PMC

References

    1. WHO Control of the Leishmaniasis. Report of a meeting of the WHO expert committee on the control of Leishmaniasis; 22 – 26 March 2010; Geneva.

    2. Important document summarizing the epidemiology and latest diagnostic and treatment recommendations for all forms of leishmaniasis, per region.

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    2. Pivotal Phase III trial demonstrating good efficacy and safety of short-course LAMB-based combination treatments against VL in India.

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