SSG&PM (East Africa)

DNDi Achievements

Sodium stibogluconate & paramomycin (SSG&PM)  Visceral leishmaniasis

Cheaper, shorter, more effective combination therapy for visceral leishmaniasis in Africa

2010

Shortening treatment length for people with visceral leishmaniasis in Africa

Although treatment options for visceral leishmaniasis in Africa had increased over the last 20 years, they had serious limitations: liposomal amphotericin B was very costly and antimonials such as sodium stibogluconate had lengthy treatment times, difficult treatment administration, emerging resistance, and poor tolerability that caused frequent side effects.

DNDi partnered with the Leishmaniasis East Africa (LEAP) Platform in clinical trials that showed the combination of sodium stibogluconate and paramomycin (SSG&PM) was as safe and effective as the existing standard treatment. With SSG&PM, treatment now lasts 17 days instead of 30 days with SSG on its own, and it costs less. This shorter treatment is easier for patients and health centres, and it means more patients can be treated during outbreaks. By combining two different drugs, SSG&PM is less likely to become ineffective due to resistance.

Since 2010, SSG&PM has been recommended by WHO as first-line treatment for visceral leishmaniasis in East Africa.

“This disease has destroyed my life. At first, I was misdiagnosed for another disease and received the wrong treatment. I lost all my money and my wife divorced me. I had to suffer five years without treatment – finally I’m receiving the right one: SSG&PM. Many hospitals in rural areas of East Africa do not have the capacity to diagnose and treat people like me.”

Key scientific articles

Safety and effectiveness of sodium stibogluconate and paromomycin combination for the treatment of visceral leishmaniasis in eastern Africa: results from a pharmacovigilance programme. Clinical Drug Investigation, January 2017
by Kimutai R, Musa AM, Njoroge S, Omollo R, Alves F, Hailu A, Khalil EAG, Diro E, Soipei P, Musa B, Salman K, Ritmeijer K, Chappuis F, Rashid J, Mohammed R, Jameneh A, Makonnen E, Olobo J, Okello L, Sagaki P, Strub N, Ellis S, Alvar J, Balasegaram M, Alirol E, Wasunna M

The Leishmaniasis East Africa Platform (LEAP): strengthening clinical trial capacity in resource-limited countries to deliver new treatments for visceral leishmaniasis. The Royal Society of Tropical Medicine & Hygiene, April 2016
by Wasunna M, Musa, A, Hailu A, Khalil EAG, Olobo J, Juma R, Wells S, Alvar J, Balasegaram M.

Sodium stibogluconate (SSG) & paromomycin combination compared to SSG for visceral leishmaniasis in East Africa: A randomized controlled trial. PLOS Neglected Tropical Diseases, June 2012
by Musa A, Khalil E, Hailu A, Olobo J, Balasegaram M, et al.

Safety and Efficacy of miltefosine alone and in combination with sodium stibogluconate and liposomal amphotericin B for the treatment of primary visceral leishmaniasis in East Africa: study protocol for a randomized controlled trial. Trials, June 2011
by Omollo R, Alexander N, Edwards T, Khalil EAG, Younis BM, Abuzaid AA, Wasunna M, Njoroge N, Kinoti D, Kirigi G, PC Dorlo TPC, Ellis S, Balasegaram M and Musa AM.

Paromomycin for the treatment of visceral leishmaniasis in Sudan: a randomized, open-label, dose-finding study. PLOS Neglected Tropical Diseases, October 2010
by Musa A, Younis B, Fadlalla A, Royce C, Balasegaram M, Wasunna M, Hailu A, Edwards T, Omollo R, Mudawi M, Kokwaro G, El-Hassan A, Khalil E.

Geographical variation in the response of visceral leishmaniasis to paromomycin in East Africa: a multicentre, open-label, randomized trial. PLOS Neglected Tropical Diseases, October 2010
by Hailu A, Musa A, Wasunna M, Balasegaram M, Yifru S, Mengistu G, Hurissa Z, Hailu W, Weldegebreal T, Tesfaye S, Makonnen E, Khalil E, Ahmed O, Fadlalla A, El-Hassan A, Raheem M, Muellerm, Koummuki Y, Rashid J, Mbui J, Mucee G, Njoroge S, Manduku V, Musibi A, Mutuma G, Kirui F, Lodenyo H, Mutea D, Kirigi G, Edwards T, Smith P, Muthami L, Royce C, Ellis S, Alobo M, Omollo R, Kesusu J, Owiti R, Kinuthia J, for the Leishmaniasis East Africa Platform (LEAP) group.

Press releases

• 1 October 2014 – Results of large-scale roll out of combination treatment for kala-azar in Eastern Africa points to urgency to treat disease victims as outbreak surges in South Sudan
• 23 September 2011 – New treatment for kala azar, the most deadly parasitic disease after malaria