title: Liposomal amphotericin B as a treatment for human leishmaniasis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Drugs for Neglected Diseases Initiative, Geneva, Switzerland.
authors.forename: Manica
authors.initials: M
authors.lastname: Balasegaram
authors.forename: Koert
authors.initials: K
authors.lastname: Ritmeijer
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Lima
authors.forename: Sakib
authors.initials: S
authors.lastname: Burza
authors.forename: Gemma
authors.initials: G
authors.lastname: Ortiz Genovese
authors.forename: Barbara
authors.initials: B
authors.lastname: Milani
authors.forename: Sara
authors.initials: S
authors.lastname: Gaspani
authors.forename: Julien
authors.initials: J
authors.lastname: Potet
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D015195:Drug Design; D016568:Drugs, Generic / Q000627:therapeutic use; D006297:Health Services Accessibility; D006801:Humans; D007896:Leishmaniasis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D013810:Therapeutic Equivalency
chemical_list: D000981:Antiprotozoal Agents; D016568:Drugs, Generic; C068538:liposomal amphotericin B; D000666:Amphotericin B