by Alves F, Bilbe G, Blesson S, Goyal V, Monnerat S, Mowbray C, Muthoni Ouattara G, Pécoul B, Rijal S, Rode J, Solomos A, Strub-Wourgaft N, Wasunna M, Wells S, Zijlstra EE, Arana B, and Alvar J. Clinical Microbiology Reviews 2018, 31(4), e00048-18, doi: 10.1128/CMR.00048-18.
Summary: This review describes successes and struggles in the treatment of visceral leishmaniasis so far, including the improved use of existing medicines but also the short-comings of current treatments, the complication of regional variation, and the discovery of under-exposure of children to miltefosine treatment. The authors review next steps for existing medicines and highlight the urgent need for new chemical entities – innovative, safe, and highly efficacious oral combination treatments that are better adapted to the remote settings where VL transmission occurs. DNDi is prioritizing their clinical development and there is now a rich portfolio of orally administered drugs identified by DNDi and/or its partners. Allowing for attrition, it is envisaged that at least one of the compounds currently under investigation will give rise to an entirely new oral medicine in the coming decade.