WHO Unveils Safer, Shorter Treatments for Deadly Kala-azar

Kala-azar is one of the world's deadliest parasitic diseases after malaria. Spread through the bite of infected sandflies, it causes high fever, weight loss, anaemia and enlargement of the spleen and liver.

The World Health Organization (WHO) has released updated treatment guidelines for visceral leishmaniasis (VL), also known as kala-azar, and post-kala-azar dermal leishmaniasis (PKDL), introducing shorter, safer and more effective treatment options for patients in eastern Africa and South-East Asia.

Kala-azar is one of the world's deadliest parasitic diseases after malaria. Spread through the bite of infected sandflies, it causes high fever, weight loss, anaemia and enlargement of the spleen and liver. Without treatment, the disease is often fatal. WHO estimates that between 50,000 and 90,000 cases occur each year across 80 countries, although only 25 to 45 percent are officially reported. The updated recommendations are expected to improve treatment outcomes while reducing the physical burden placed on patients.

New therapies replace lengthy injectable treatments

For many years, treatment in eastern Africa relied heavily on sodium stibogluconate (SSG), an injectable medicine that required painful daily injections over several weeks and was linked to significant side effects.

For the first time, WHO recommends treatment options that do not rely on SSG for eligible patients. In eastern Africa, the organisation now recommends a combination of the oral medicine miltefosine and paromomycin injections for treating both visceral leishmaniasis and PKDL. The new regimen shortens treatment to 14 days, reduces the number of injections and lowers the risk of toxic side effects compared with the previous 17-day treatment.

In South-East Asia, WHO now recommends shorter combination therapies using liposomal amphotericin B, either alone or together with oral miltefosine, for patients with PKDL. Updated guidance has also been issued for managing relapsed visceral leishmaniasis cases in patients with healthy immune systems.

Better outcomes for patients and communities

PKDL is a skin condition that can develop after recovery from kala-azar. Although it is not usually life-threatening, it can serve as a source of further infection and often exposes patients to stigma, social isolation and mental health challenges.

WHO estimates that nearly half of primary kala-azar patients and all PKDL patients could benefit from the updated recommendations. The guidelines also include revised safety advice for miltefosine, including updated dosing recommendations based on body size.

WHO Director of Malaria and Neglected Tropical Diseases Dr Daniel Ngamije Madandi said the new guidance marks a major step forward by replacing difficult treatment regimens with options that are safer, shorter and more suitable for patients, strengthening efforts to eliminate the disease across Africa and Asia.

Research partnership drives medical progress

Many of the newly recommended therapies were developed by the Drugs for Neglected Diseases initiative (DNDi) and its research partners. DNDi said the recognition of these treatments in WHO guidelines is an important milestone while work continues on developing LXE408, a new oral medicine that could eventually remove the need for injectable treatments.

Countries affected by visceral leishmaniasis are now expected to update their national treatment protocols to reflect the new WHO recommendations. Kenya's Ministry of Health said it is already working to incorporate the changes into national guidelines so patients can benefit from improved treatments as quickly as possible.