Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance

S. Rijal; B. Ostyn; S. Uranw; K. Rai; N.R. Bhattarai; T.P. Dorlo; J.H. Beijnen; M. Vanaerschot; S. Decuypere; S.S. Dhakal; M.L. Das; P. Karki; R. Singh; M. Boelaert; J.C. Dujardin

doi:10.1093/cid/cit102

Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance

S. Rijal, B. Ostyn, S. Uranw, K. Rai, N.R. Bhattarai, T.P. Dorlo, J.H. Beijnen, M. Vanaerschot, S. Decuypere, S.S. Dhakal, M.L. Das, P. Karki, R. Singh, M. Boelaert, J.C. Dujardin

Molecular Parasitology

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

Background. Miltefosine (MIL), the only oral drug for visceral leishmaniasis (VL), is currently the 1(st) line therapy in the VL elimination program of the Indian subcontinent. Given the paucity of anti-VL drugs and the looming threat of resistance, there is an obvious need for close monitoring of clinical efficacy of MIL. Methods. In a cohort study of 120 VL patients treated with MIL in Nepal, we monitored the clinical outcomes up to 12 after completion of therapy and explored the potential role of drug compliance, parasite drug resistance and re-infection. Results. The initial cure rate was 95.8% (95% C.I. +/-3.6%)and relapse rate at six and twelve months was 10.8% (95% C.I.+/-5.6%) and 20.0% (95% C.I.+/-7.2%) respectively. No significant clinical risk factors of relapse apart from age

Original language	English
Journal	Clinical Infectious Diseases
Volume	56
Issue number	11
Pages (from-to)	1530-1538
Number of pages	9
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/cit102
Publication status	Published - 2013

Keywords

Protozoal diseases
Kala azar
Visceral
Leishmaniasis
Leishmania donovani
Vectors
Sandflies
Control programs
Mass drug therapy
Drug resistance
Miltefosine
Reinfection
Treatment failure
Compliance
Relapses
Nepal
Asia-South

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Rijal, S., Ostyn, B., Uranw, S., Rai, K., Bhattarai, N. R., Dorlo, T. P., Beijnen, J. H., Vanaerschot, M., Decuypere, S., Dhakal, S. S., Das, M. L., Karki, P., Singh, R., Boelaert, M., & Dujardin, J. C. (2013). Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance. Clinical Infectious Diseases, 56(11), 1530-1538. https://doi.org/10.1093/cid/cit102

@article{dccdce39677b4654b343143917688056,

title = "Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance",

abstract = "Background. Miltefosine (MIL), the only oral drug for visceral leishmaniasis (VL), is currently the 1(st) line therapy in the VL elimination program of the Indian subcontinent. Given the paucity of anti-VL drugs and the looming threat of resistance, there is an obvious need for close monitoring of clinical efficacy of MIL. Methods. In a cohort study of 120 VL patients treated with MIL in Nepal, we monitored the clinical outcomes up to 12 after completion of therapy and explored the potential role of drug compliance, parasite drug resistance and re-infection. Results. The initial cure rate was 95.8% (95% C.I. +/-3.6%)and relapse rate at six and twelve months was 10.8% (95% C.I.+/-5.6%) and 20.0% (95% C.I.+/-7.2%) respectively. No significant clinical risk factors of relapse apart from age",

keywords = "Protozoal diseases, Kala azar, Visceral, Leishmaniasis, Leishmania donovani, Vectors, Sandflies, Control programs, Mass drug therapy, Drug resistance, Miltefosine, Reinfection, Treatment failure, Compliance, Relapses, Nepal, Asia-South",

author = "S. Rijal and B. Ostyn and S. Uranw and K. Rai and N.R. Bhattarai and T.P. Dorlo and J.H. Beijnen and M. Vanaerschot and S. Decuypere and S.S. Dhakal and M.L. Das and P. Karki and R. Singh and M. Boelaert and J.C. Dujardin",

note = "PPU; ITG-H2B; ITG-H3B; ITG-B8B; ITG-B9B; ITG-H14A; ITG-BLA; MULTI; DPH; U-ECTD; DBM; U-MOLPAR; JIF; DOI; PDF; Abstract; DSPACE56",

year = "2013",

doi = "10.1093/cid/cit102",

language = "English",

volume = "56",

pages = "1530--1538",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "11",

}

Rijal, S, Ostyn, B, Uranw, S, Rai, K, Bhattarai, NR, Dorlo, TP, Beijnen, JH, Vanaerschot, M, Decuypere, S, Dhakal, SS, Das, ML, Karki, P, Singh, R, Boelaert, M & Dujardin, JC 2013, 'Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance', Clinical Infectious Diseases, vol. 56, no. 11, pp. 1530-1538. https://doi.org/10.1093/cid/cit102

TY - JOUR

T1 - Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance

AU - Rijal, S.

AU - Ostyn, B.

AU - Uranw, S.

AU - Rai, K.

AU - Bhattarai, N.R.

AU - Dorlo, T.P.

AU - Beijnen, J.H.

AU - Vanaerschot, M.

AU - Decuypere, S.

AU - Dhakal, S.S.

AU - Das, M.L.

AU - Karki, P.

AU - Singh, R.

AU - Boelaert, M.

AU - Dujardin, J.C.

N1 - PPU; ITG-H2B; ITG-H3B; ITG-B8B; ITG-B9B; ITG-H14A; ITG-BLA; MULTI; DPH; U-ECTD; DBM; U-MOLPAR; JIF; DOI; PDF; Abstract; DSPACE56

PY - 2013

Y1 - 2013

N2 - Background. Miltefosine (MIL), the only oral drug for visceral leishmaniasis (VL), is currently the 1(st) line therapy in the VL elimination program of the Indian subcontinent. Given the paucity of anti-VL drugs and the looming threat of resistance, there is an obvious need for close monitoring of clinical efficacy of MIL. Methods. In a cohort study of 120 VL patients treated with MIL in Nepal, we monitored the clinical outcomes up to 12 after completion of therapy and explored the potential role of drug compliance, parasite drug resistance and re-infection. Results. The initial cure rate was 95.8% (95% C.I. +/-3.6%)and relapse rate at six and twelve months was 10.8% (95% C.I.+/-5.6%) and 20.0% (95% C.I.+/-7.2%) respectively. No significant clinical risk factors of relapse apart from age

AB - Background. Miltefosine (MIL), the only oral drug for visceral leishmaniasis (VL), is currently the 1(st) line therapy in the VL elimination program of the Indian subcontinent. Given the paucity of anti-VL drugs and the looming threat of resistance, there is an obvious need for close monitoring of clinical efficacy of MIL. Methods. In a cohort study of 120 VL patients treated with MIL in Nepal, we monitored the clinical outcomes up to 12 after completion of therapy and explored the potential role of drug compliance, parasite drug resistance and re-infection. Results. The initial cure rate was 95.8% (95% C.I. +/-3.6%)and relapse rate at six and twelve months was 10.8% (95% C.I.+/-5.6%) and 20.0% (95% C.I.+/-7.2%) respectively. No significant clinical risk factors of relapse apart from age

KW - Protozoal diseases

KW - Kala azar

KW - Visceral

KW - Leishmaniasis

KW - Leishmania donovani

KW - Vectors

KW - Sandflies

KW - Control programs

KW - Mass drug therapy

KW - Drug resistance

KW - Miltefosine

KW - Reinfection

KW - Treatment failure

KW - Compliance

KW - Relapses

KW - Nepal

KW - Asia-South

U2 - 10.1093/cid/cit102

DO - 10.1093/cid/cit102

M3 - A1: Web of Science-article

C2 - 23425958

SN - 1058-4838

VL - 56

SP - 1530

EP - 1538

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 11

ER -

Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance

Abstract

Keywords

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