Amphotericin B lipid complex: in visceral leishmaniasis

Area of Science:

• Infectious Diseases
• Pharmacology
• Tropical Medicine

Background:

• Visceral leishmaniasis (VL) is a serious parasitic disease.
• Antimonial drugs are a common treatment for VL, but resistance is increasing.
• Amphotericin B lipid complex (ABLC) is a lipid formulation of amphotericin B, an antifungal with activity against Leishmania spp.

Purpose of the Study:

• To evaluate the efficacy and tolerability of ABLC in patients with VL.
• To compare ABLC with other amphotericin B formulations and standard treatments.

Main Methods:

• Randomised, open-label, dose-ranging studies were conducted.
• Short-course, once-daily intravenous infusions of ABLC were administered.
• Studies included patients with antimonial-resistant VL, previously untreated VL, and HIV-infected patients with VL.

Main Results:

• High rates of apparent (93-100%) and definitive (79-100%) cures were observed with ABLC in Indian patients with antimonial-resistant VL.
• ABLC demonstrated comparable efficacy to liposomal amphotericin B and conventional amphotericin B deoxycholate formulation in a mixed Indian population.
• In HIV-infected patients with VL, ABLC showed similar effectiveness to meglumine antimonate in a small pilot study in southern Europe.
• Infusion-related reactions were the most frequent adverse events associated with ABLC.

Conclusions:

• Short-course ABLC treatment is effective and well-tolerated for visceral leishmaniasis, including antimonial-resistant cases.
• ABLC represents a viable alternative treatment option for VL, particularly in resource-limited settings.
• Further research is warranted to explore ABLC's role in HIV-VL co-infection.