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Fekadu A, Teferra S, Hailu A, Gebre-Mariam T, Addissie A, Deressa W, Yimer G, Reja A. International Clinical Trial Day and clinical trials in Ethiopia and Africa. Trials 2014; 15:493. [PMID: 25526797 PMCID: PMC4300613 DOI: 10.1186/1745-6215-15-493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/26/2014] [Indexed: 11/26/2022] Open
Abstract
Low income countries like Ethiopia are underrepresented in clinical research. As a major public commitment to clinical research, Ethiopia celebrated the International Clinical Trial Day (ICTD) for the first time on 20 May 2014 under the auspices of Addis Ababa University. The motto for the day was 'Clinical Trials for Excellence in Patient Care'. The celebration offered an opportunity to inform academic staff, researchers, students and the leadership about clinical trials being conducted and to discuss the future of clinical trials in the country. Although clear challenges to the conduct of trials abound, clinical trials registered from Ethiopia in trial registration databases is increasing. Cross-country collaborations, international funding support, motivation of academic staff to conduct clinical trials and the commitment and engagement of the leadership in research are all improving. The overall impact of clinical trials is also encouraging. For example, some of the trials conducted in Ethiopia have informed treatment guidelines. However, administrative capacity, research infrastructure as well as financial support remain weak. There is a need for enhanced university-industry linkage and translation of research findings into locally relevant evidence. Ethiopia, as well as the whole of Africa, has an unparalleled opportunity to lead the way in clinical trials, given its prospect of development and the need to have locally relevant evidence for its growing population. In this commentary we reflect on the celebration of ICTD, the status and opportunities for conducting clinical trials and the way forward for facilitating clinical trials in Ethiopia and Africa.
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Affiliation(s)
- Abebaw Fekadu
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
- />Department of Psychological Medicine,, Centre for Affective Disorders, Institute of Psychiatry, King’s College London, DeCrespigny Park, SE5 8AF London, UK
| | - Solomon Teferra
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
| | - Asrat Hailu
- />Department of Microbiology, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
| | - Tsige Gebre-Mariam
- />Regional Bioequivalence Center, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 31708, Addis Ababa, Ethiopia
| | - Adamu Addissie
- />School of Public Health, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- />School of Public Health, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
| | - Getnet Yimer
- />Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
| | - Ahmed Reja
- />College of Health Sciences, Addis Ababa University, Zambia Street, PO Box 9086, Addis Ababa, Ethiopia
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Abstract
INTRODUCTION Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic. AREAS COVERED A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice for East African VL. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. EXPERT OPINION There is an urgent need to implement a single-dose L-AmB or combination therapy in the Indian subcontinent. Shorter and more acceptable regimens are needed for the treatment of post - kala-azar dermal leishmaniasis. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend toward local treatment for New World CL is preferred in patients without risk of mucosal disease.
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Affiliation(s)
- Shyam Sundar
- Banaras Hindu University, Institute of Medical Sciences, Department of Medicine , Varanasi , India +91 542 2369632 ;
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