title: Pharmacovigilance of Miltefosine in Treatment of Visceral Leishmaniasis in Endemic Areas of Bihar, India.
abstract: Miltefosine, the only oral drug for visceral leishmaniasis (VL), is being used as the first-line drug under the VL elimination program in the Indian subcontinent. Miltefosine is an oral drug which was used as a topical application for skin metastasis of breast cancer. It was found to be effective against Leishmania donovani The main adverse events (AE) reported previously with miltefosine use includes diarrhea, vomiting, and dehydration. Other AEs include, raised serum alanine transaminase/aspartate aminotransferase and renal parameters such as creatinine. In this study, we report AEs in a large patient cohort of VL treated with miltefosine. The purpose of this pharmacovigilance study was to assess adverse drug reactions (ADRs)/AE of miltefosine treatment under unrestricted condition in the field setup. Patients were followed up to 6 months for therapeutic effectiveness. Outcomes of a larger data set of patients treated with this regimen from April 2012 to March 2015 were recorded. In the present study, 646 patients of VL were given miltefosine. Majority of the study subjects (58%) were male. Relapse occurred in 7% during follow-up period. Main causes of death were VL-pulmonary tuberculosis coinfection, extreme diarrhea, and acute pancreatitis which were reported in 1.7% subjects. Of 553 (85.6%) patients completing full course of treatment, 463 (83.7%) showed ADR with miltefosine during the study period. About 2.3% were suffering severe ADR, 51% from moderate, and the rest had mild ADR. The initial and final cure rate was 97.4% and 85.6%, respectively.
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India.
authors.forename: Krishna
authors.initials: K
authors.lastname: Pandey
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India.
authors.forename: Vidyanand
authors.initials: V
authors.lastname: Ravidas
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India.
authors.forename: Niyamat A
authors.initials: NA
authors.lastname: Siddiqui
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Sinha
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India.
authors.forename: Rakesh B
authors.initials: RB
authors.lastname: Verma
authors.affiliation: Sadar Hospital, East Champaran, Bihar, India.
authors.forename: Tripurari P
authors.initials: TP
authors.lastname: Singh
authors.affiliation: Directorate of National Vector Borne Disease Control Programme (NVBDCP), Delhi, India.
authors.forename: A C
authors.initials: AC
authors.lastname: Dhariwal
authors.affiliation: Directorate of National Vector Borne Disease Control Programme (NVBDCP), Delhi, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Das Gupta
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India. drpradeep.das@gmail.com.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D015331:Cohort Studies; D060085:Coinfection; D003967:Diarrhea / Q000150:complications; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D007893:Leishmania donovani / Q000187:drug effects; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D010349:Patient Compliance; D060735:Pharmacovigilance; D010767:Phosphorylcholine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D010767:Phosphorylcholine; C039128:miltefosine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase