Assoc. Prof. David Meya in collaboration with researchers from the UK, Malawi, South Africa, France, Zimbabwe, Botswana and Uganda have discovered that a liposomal formulation of amphotericin B called AmBisome may be well suited to treat cryptococcal meningitis. In their latest publication released by the New England Journal of Medicine on March 23 2022, the researchers found that a single, high-dose of AmBisome was effective at clearing Cryptococcus from around the brain. AmBisome, delivered in tiny lipid-based packages (liposomes), can be given in large doses that remain in the brain for some time and is less toxic compared to standard therapy.
The current treatments for cryptococcal meningitis in sub-Saharan Africa are either a seven to 14-day course of amphotericin-B combined with oral antifungal tablets or oral fluconazole. Ten week mortality with fluconazole treatment remains at approximately 60% and standard treatment with amphotericin-B is not widely available across Africa.
“We found that a single, high-dose of liposomal amphotericin B was much easier to give, requiring just one intravenous infusion compared to seven days with standard therapy. The liposomal amphotericin B regimen was also associated with significantly fewer drug related effects such as anemia, electrolyte abnormalities and intravenous line site infections,” partly reads a press release on the London School of Hygiene and Tropical Medicine (LSHTM) website.
The findings are a result of the largest HIV- associated Cryptococcal Meningitis treatment trial ever undertaken named AMBITION-cm. The trial investigated whether a single high dose of liposomal amphotericin-B (L-AmB, Ambisome) paired with two oral antifungals, fluconazole and flucytosine, was as effective as 7-day amphotericin-B based therapy in reducing deaths. It recruited individuals from eight hospitals across seven cities in 5 countries in southern and eastern Africa
Assoc. Prof. Meya has led the inclusion of this new first line treatment regimen for cryptococcal meningitis in the Ugandan guidelines, which are currently undergoing review.