Randomised controlled trial of aminosidine (paromomycin) v sodium stibogluconate for treating visceral leishmaniasis in North Bihar, India Commentary: Some good news for treatment of visceral leishmaniasis in Bihar

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Abstract
Objectives: To assess the efficacy and tolerability of aminosidine compared with sodium stibogluconate for treating visceral leishmaniasis. Design: Randomised, unblinded, controlled trial with 180 day follow up. Setting: Kala-Azar Research Centre, Brahmpura, Muzaffarpur, Bihar, India. Subjects: People of either sex aged 6-50 years with symptoms and signs suggestive of visceral leishmaniasis (fever, loss of appetite, enlarged spleen) with leishmania amastigotes detected in Giemsa stained aspirates of spleen or bone marrow. Interventions: Aminosidine at three daily doses (12, 16, and 20 mg/kg) for 21 days and sodium stibogluconate 20 mg/kg/day for 30 days. Main outcome measures: Laboratory measures of efficacy: parasite count, haemoglobin concentration, white cell count, platelet count, serum albumin concentration. Clinical measures of efficacy: spleen size, fever, body weight, and liver size. Measures of safety: liver and renal function tests, reports of adverse events. Results: Of the 120 patients enrolled (30 per treatment arm), 119 completed treatment and follow up. Cure at end of follow up was achieved in 23 (77%), 28 (93%), and 29 (97%) patients treated with 12, 16, and 20 mg aminosidine/kg/day respectively, and in 19 (63%) patients given sodium stibogluconate. At 16 and 20 mg/kg/day, aminosidine was significantly more active than sodium stibogluconate in both clinical and laboratory measures of efficacy. No significant clinical or laboratory toxicity occurred in any treatment group. Conclusions: A 21 day course of aminosidine 16 or 20 mg/kg/day should be considered as first line treatment for visceral leishmaniasis in Bihar. Bihar in north east India accounts for about half the annual worldwide cases of visceral leishmaniasis, and resistance to standard treatment with sodium stibogluconate has been increasing We compared the safety and efficacy of three doses of aminosidine with standard regimen of sodium stibogluconate for treating visceral leishmaniasis in Bihar Aminosidine given at 16 or 20 mg/kg/day for 21 days was significantly more effective in producing final cure than sodium stibogluconate 20 mg/kg/day for 30 days Aminosidine had a low incidence of adverse reactions, including ototoxicity and renal toxicity, and was well tolerated Intramuscular injection of aminosidine 16 mg/kg/day for 21 days should be considered as a new first line treatment for visceral leishmaniasis in Bihar Objectives: To assess the efficacy and tolerability of aminosidine compared with sodium stibogluconate for treating visceral leishmaniasis. Design: Randomised, unblinded, controlled trial with 180 day follow up. Setting: Kala-Azar Research Centre, Brahmpura, Muzaffarpur, Bihar, India. Subjects: People of either sex aged 6-50 years with symptoms and signs suggestive of visceral leishmaniasis (fever, loss of appetite, enlarged spleen) with leishmania amastigotes detected in Giemsa stained aspirates of spleen or bone marrow. Interventions: Aminosidine at three daily doses (12, 16, and 20 mg/kg) for 21 days and sodium stibogluconate 20 mg/kg/day for 30 days. Main outcome measures: Laboratory measures of efficacy: parasite count, haemoglobin concentration, white cell count, platelet count, serum albumin concentration. Clinical measures of efficacy: spleen size, fever, body weight, and liver size. Measures of safety: liver and renal function tests, reports of adverse events. Results: Of the 120 patients enrolled (30 per treatment arm), 119 completed treatment and follow up. Cure at end of follow up was achieved in 23 (77%), 28 (93%), and 29 (97%) patients treated with 12, 16, and 20 mg aminosidine/kg/day respectively, and in 19 (63%) patients given sodium stibogluconate. At 16 and 20 mg/kg/day, aminosidine was significantly more active than sodium stibogluconate in both clinical and laboratory measures of efficacy. No significant clinical or laboratory toxicity occurred in any treatment group. Conclusions: A 21 day course of aminosidine 16 or 20 mg/kg/day should be considered as first line treatment for visceral leishmaniasis in Bihar. Bihar in north east India accounts for about half the annual worldwide cases of visceral leishmaniasis, and resistance to standard treatment with sodium stibogluconate has been increasing We compared the safety and efficacy of three doses of aminosidine with standard regimen of sodium stibogluconate for treating visceral leishmaniasis in Bihar Aminosidine given at 16 or 20 mg/kg/day for 21 days was significantly more effective in producing final cure than sodium stibogluconate 20 mg/kg/day for 30 days Aminosidine had a low incidence of adverse reactions, including ototoxicity and renal toxicity, and was well tolerated Intramuscular injection of aminosidine 16 mg/kg/day for 21 days should be considered as a new first line treatment for visceral leishmaniasis in Bihar

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