Post-marketing study to assess the safety, tolerability and effectiveness of FungisomeTM: An Indian Liposomal amphotericin B Preparation

Background : In May 2003, an indigenously developed liposomal amphotericin B (FungisomeTM) was introduced in the Indian market for the treatment of systemic fungal infections and visceral leishmaniasis. The present post marketing study assessed the safety and effectiveness of FungisomeTM in actual clinical practice. Setting and Design : Retrospective post marketing surveillance from four cities of India. Methods : The present study was carried out for a period of 6 months (Jun-Nov 2004), a year after the introduction of the drug. A list of doctors who had prescribed and procured the drug was obtained from the distributor. Consent to participate and scrutinize the patients′ source notes were obtained from the concerned doctors. All patients who had received FungisomeTM treatment were included. Data was collected from the patient′s source notes on a predesigned proforma. They were then analyzed by descriptive statistics. Cost of FungisomeTM was calculated on the basis of dose used and number of days of treatment Results : Data were available for 109/144 patients from 35/40 physicians. FungisomeTM was administered at 1-3 mg/kg/day for 7-76 days. No serious adverse events related to the drug were observed in the study. Mild infusion-related adverse events were reported in 40 (36% ), moderate in 11 (10%) of patients and severe in 2 (1.8% ). None of the adverse events were certain to FungisomeTM exposure, 12 (11 %) were probable, 28 (25 %) were possible, and 13 (11.9%) were unlikely. Of the 91 assessable patients (received at least eight doses of FungisomeTM) for efficacy complete response was observed in 67 (73.6%), 16 (17.5% ) had partial responses, and 8 (8.7%) of patients had no response. The acquisition cost per day and per course treatment of different fungal infections ranged from (apprx) Rs 4500-8000 and 0.9 -2.1 lakh respectively. Conclusion : This postmarketing study documents the safety, tolerability, effectiveness and cost advantage of indigenously developed liposomal amphotericin B in the treatment of systemic fungal infections and febrile neutropenia in actual clinical practice.