One World, One People.

Rapid Impact Packages

2007-12-17T12:51:00.001-08:00

The Rapid Impact Packages (RIP)have been introduced by the global network for neglected tropical diseases (NTD), with the aim of helping to reduce the prevalence of soil transmitted helminthiasis, filariasis, river blindness, and trachoma in the third world countries. These disease currently ravage the under served and poverty stricken populations of the third world. This is a blister pack combination of 4 drugs donated by pharmaceuticals and NGOs' to countries in Asia, Africa and South America. Some of the drugs are currently not yet free abut are being made available at a subsidized cost. The list of diseases and their cures included in the rapid impact packages are as follows.

1. Onchocerciasis (River Blindness) - Ivermectin - currently being donated by Merck. Cost 0 cents.

2. STH (Soil Transmitted Hemlminthiasis - includes ascariasis, trichuriasis and hook worm infestation)- Albendazole- GSK - 2 cents.

3. Trachoma - Azithromycin- Pfizer - o cents.

4. Lymphatic filariasis- Ivermectin- Merck - 0 cents

5. Schistosomiasis - Praziquantel- Med Pharm- 8 cents.

This 50 cents still proves to be a lot for many third world countries, especially those with poor governance and ongoing civil and military conflicts. The PUSH fund has been established to try and overcome this deficit. Let us combine to make this a success.

Kala Azar

2007-12-17T12:30:00.000-08:00

Injectable Paramomycin for Visceral Leishmaniasis (Kala Azar) in India

Sunder, S et al. N Engl J Med 2007;356:2571-81 (www.nejm.org)

Background Visceral leishmaniasis (kala-azar) affects large,rural, resource-poor populations in South Asia, Africa, andBrazil. Safe, effective, and affordable new therapies are needed.We conducted a randomized, controlled, phase 3 open-label studycomparing paromomycin, an aminoglycoside, with amphotericinB, the present standard of care in Bihar, India.

Methods In four treatment centers for visceral leishmaniasis,667 patients between 5 and 55 years of age who were negativefor the human immunodeficiency virus and had parasitologicallyconfirmed visceral leishmaniasis were randomly assigned in a3:1 ratio to receive paromomycin (502 patients) at a dose of11 mg per kilogram of body weight intramuscularly daily for21 days or amphotericin B (165 patients) at a dose of 1 mg perkilogram intravenously every other day for 30 days. Final curewas assessed 6 months after the end of treatment; safety assessmentsincluded daily clinical evaluations and weekly laboratory andaudiometric evaluations. Noninferiority testing was used tocompare 6-month cure rates, with a chosen margin of noninferiorityof 10 percentage points.

Results Paromomycin was shown to be noninferior to amphotericinB (final cure rate, 94.6% vs. 98.8%; difference, 4.2 percentagepoints; upper bound of the 97.5% confidence interval, 6.9; P<0.001).Mortality rates in the two groups were less than 1%. Adverseevents, which were more common among patients receiving paromomycinthan among those receiving amphotericin B (6% vs. 2%, P=0.02),included transient elevation of aspartate aminotransferase levels(>3 times the upper limit of the normal range); transientreversible ototoxicity (2% vs. 0, P=0.20); and injection-sitepain (55% vs. 0, P<0.001);> B, as compared with those receiving paromomycin, nephrotoxicity(4% vs. 0, P<0.001),> 0, P<0.001),>

Neglected Tropical Diseases

2007-12-17T09:17:00.000-08:00

From 1975 to 1999 only 13 drugs from 1393 new chemical entities (NCE) marketed, were for neglected tropical diseases (NTD). Over the past 30 years, number of drugs for NTD are 10, 18 if you consider Malaria, and 21 if you consider TB. This represents a lamenting 1% of all the NCE (1556) launched till 2007. Today majority of the worlds population lives under poverty, struggling for basic access to health care. Diseases such as malaria, TB, HIV, Kala Azar, sleeping sickness and soil transmitted helminthiasis cause extensive morbidity and mortality destroying the very social and economic fabric of the country. But all is not lost, work from orgnaizations such as medicine sans frontier, institute of one world health and drugs for neglected diseases initiative is bringing back much needed attention to this domain. Kala Azar is one such example, where the IOWH pioneered the efforts to bring a cheap and relatively safe alternative treatment Paramomycin to India in the treatment of patients with the disease, thus giving hope to thousands of patients, especially children affected by the parasite (In India 40-60% of patients with Kala Azar have resistance to first line agent sodium stibogluconate).