Shorter and safer visceral leishmaniasis first-line treatment for people in the Americas

More accessible treatment recommended by PAHO

Until recently, first-line treatment recommendations for visceral leishmaniasis in Brazil included the use of meglumine antimoniate, which presents serious patient management limitations due to toxicity, parenteral administration, and the need for hospitalization.

Starting in 2011, a multicentre, randomized, open label, controlled trial was conducted in five sites in Brazil to evaluate the efficacy and safety of various treatment options compared to the standard, antimonial-based treatment. The collaborative study was sponsored by the Brazilian Ministry of Health and coordinated by the University of Brasilia, the Oswaldo Cruz Foundation of Brazil, and DNDi. Results showed that due to lower toxicity and acceptable efficacy, liposomal amphotericin B was a more suitable first-line treatment for visceral leishmaniasis than standard treatment. This treatment is more accessible for people because of its shorter duration, fewer side effects and reduced hospitalization time.

In 2013, based on the interim safety data from the trial, Brazil’s national guidelines for visceral leishmaniasis were revised to include treatment with liposomal amphotericin B for some patients.

In June 2022, the Pan American Health Organization (PAHO) published new guidelines recommending liposomal amphotericin B instead of pentavalent antimonials.

Treatment regimens

• Indication: Visceral leishmaniasis in the Americas
• Dosage: Liposomal amphotericin B given intravenously for 7 days

Impact

• Changed the recommendation of first-line treatment for visceral leishmaniasis in PAHO’s guidelines replacing the antimonial-based treatment by liposomal amphotericin B, a shorter and safer treatment.
• The PAHO guidelines can help national programmes strengthen and expand diagnosis and treatment for people affected by this neglected disease.