内脏利什曼病的治疗:安必素的异常定价与分销以及本土脂质体两性霉素B(FUNGISOME)的出现

Treatment of visceral leishmaniasis: anomalous pricing and distribution of AmBisome and emergence of an indigenous liposomal amphotericin B, FUNGISOME.

作者信息

Bhattacharya Pradyot, Ali Nahid

机构信息

Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, 4, Raja SC Mullick Road, Jadavpur, Kolkata, 700032 West Bengal India.

出版信息

J Parasit Dis. 2016 Sep;40(3):1094-5. doi: 10.1007/s12639-014-0607-3. Epub 2014 Nov 1.

Abstract

Visceral leishmaniasis (VL) is one of the severest forms of parasite borne diseases worldwide with a mortality rate second only to malaria. Treatment of VL patients with currently available chemotherapeutic agents poses problems of large scale failure, toxicity, prolonged hospitalization time, high treatment cost and drug resistance. However, most of these problems can be overcome by the use of liposomal formulations of Amphotericin B (L-AmB). Of the two L-AmBs currently available in Indian market, AmBisome is imported and FUNGISOME is indigenous. Initially AmBisome remained exorbitantly costly and therefore inaccessible to most of the VL patients. However, with the launch of FUNGISOME in India, Gilead in agreement with WHO started a donation program of AmBisome in developing countries through a slashed price of US $18 per vial. The price reduction is, however, restricted to clinical trials thus eluding majority of the VL patients. In fact, India was not included in this program and AmBisome was sold in Indian market at prices higher than the WHO proposed price of US $18 per vial. FUNGISOME, on the other hand, produced consistently good results against VL both clinically and experimentally. In the context of unavailability and price anomaly of AmBisome, successful emergence of FUNGISOME could mark it as the major L-AmB against VL.

摘要

内脏利什曼病(VL)是全球最严重的寄生虫病之一,死亡率仅次于疟疾。用目前可用的化疗药物治疗VL患者存在大规模治疗失败、毒性、住院时间延长、治疗成本高和耐药性等问题。然而,使用两性霉素B脂质体制剂(L-AmB)可以克服这些问题中的大多数。印度市场目前有两种L-AmB,安必素是进口的,而真菌脂质体是国产的。最初,安必素价格高得离谱,因此大多数VL患者用不起。然而,随着真菌脂质体在印度上市,吉利德公司与世卫组织达成协议,通过将每瓶价格降至18美元,在发展中国家启动了安必素捐赠计划。然而,价格降低仅限于临床试验,因此大多数VL患者无法受益。事实上,印度未被纳入该计划,安必素在印度市场的售价高于世卫组织提议的每瓶18美元的价格。另一方面,真菌脂质体在临床和实验上对VL均产生了持续良好的效果。在安必素供应不足和价格异常的情况下,真菌脂质体的成功出现可能使其成为治疗VL的主要L-AmB。

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