Paving the way for affordable and equitable liposomal amphotericin B access worldwide
Janice Soo Fern Lee, Rachel Cohen, Rahela Ambaras Khan, Jessica Burry, Esther C. Casas, H.Y. Chung, Luiz Henrique Costa, Nathan Ford, Diogo Lopes Nunes Galvao, Nora Girón, Joseph N Jarvis, M. M. H. Mondal, Justine Jelagat Odionyi, Carmen Pérez Casas, Ajay Rangaraj, Joelle Rode, Carol Ruffell, Omar Sued, Isabela Ribeiro
Abstract
Amphotericin B has long been crucial for treating many serious infectious diseases, such as invasive fungal infections and visceral leishmaniasis, particularly for patients who are immunocompromised, including those with advanced HIV infection. The conventional amphotericin B deoxycholate formulation has largely been replaced in high-income countries with liposomal amphotericin B (LAmB), which has many advantages, including lower rates of adverse events, such as nephrotoxicity and anaemia. Despite an evident need for LAmB in low-income and middle-income countries, where mortality from invasive fungal infections is still substantial, many low-income and middle-income countries still often use the amphotericin B deoxycholate formulation because of a small number of generic formulations and the high price of the originator LAmB. The pricing of LAmB is also highly variable between countries. Overcoming supply barriers through the availability of additional quality-assured, generic formulations of LAmB at accessible prices would substantially facilitate equitable access and have a substantial effect on mortality attributable to deadly fungal infections.