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Professor Philippe Guérin
Professor
Philippe
Guérin
Director
IDDO
Research Theme
Medicine quality
Visceral leishmaniasis
Antimicrobial resistance
Schistosomiasis & STHs
COVID19
Trachoma
WWARN

Professor Philippe Guérin is Director of the Infectious Diseases Data Observatory (IDDO). He was appointed Director of the WorldWide Antimalarial Research Network (WWARN) - the prototypic model for IDDO - in January 2009. Philippe has extensive experience working in the field for Médecins Sans Frontières and as a researcher for a Wellcome Trust Research Unit in many countries in Africa and Asia. Following three years as a Senior Advisor to the Department of Infectious Disease Epidemiology at the Norwegian Institute of Public Health, Philippe joined Épicentre in Paris - a World Health Organization (WHO) Collaborating Centre for Research in epidemiology and response to emerging diseases. Philippe served as Scientific Director for six years at Épicentre before moving to WWARN. 

Post-kala-azar dermal leishmaniasis (PKDL) drug efficacy study landscape: A systematic scoping review of clinical trials and observational studies to assess the feasibility of establishing an individual participant-level data (IPD) platform

PLOS NTDs
Published
16 Apr 2024
Authors
Sauman Singh-Phulgenda, Rishikesh Kumar, Prabin Dahal, Abdalla Munir, Sumayyah Rashan, Rutuja Chhajed, Caitlin Naylor, Brittany J. Maguire, Niyamat Ali Siddiqui, Eli Harriss, Manju Rahi, Fabiana Alves, Shyam Sundar, Kasia Stepniewska, Ahmed Musa,
Philippe J. Guerin, Krishna Pandey

Abstract

Background

Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis which can occur after successful treatment of visceral leishmaniasis (VL) and is a public health problem in VL endemic areas. We conducted a systematic scoping review to assess the characteristics of published PKDL clinical studies, understand the scope of research and explore the feasibility and value of developing a PKDL individual patient data (IPD) platform.

Methods

A systematic review of published literature was conducted to identify PKDL clinical studies by searching the following databases: PubMed, Scopus, Ovid Embase, Web of Science Core Collection, WHO Global Index Medicus, PASCAL, Clinicaltrials.gov, Ovid Global Health, Cochrane Database and CENTRAL, and the WHO International Clinical Trials Registry Platform. Only prospective studies in humans with PKDL diagnosis, treatment, and follow-up measurements between January 1973 and March 2023 were included. Extracted data includes variables on patient characteristics, treatment regimens, diagnostic methods, geographical locations, efficacy endpoints, adverse events and statistical methodology.

Results

A total of 3,418 records were screened, of which 56 unique studies (n = 2,486 patients) were included in this review. Out of the 56 studies, 36 (64.3%) were from India (1983–2022), 12 (21.4%) from Sudan (1992–2021), 6 (10.7%) were from Bangladesh (1991–2019), and 2 (3.6%) from Nepal (2001–2007). Five (8.9%) studies were published between 1981–1990 (n = 193 patients), 10 (17.9%) between 1991–2000 (n = 230 patients), 10 (17.9%) between 2001–2010 (n = 198 patients), and 31 (55.4%) from 2011 onwards (n = 1,865 patients). Eight (14.3%) were randomised clinical trials, and 48 (85.7%) were non-randomised studies. The median post-treatment follow-up duration was 365 days (range: 90–540 days) in 8 RCTs and 360 days (range: 28–2,373 days) in 48 non-randomised studies. Disease diagnosis was based on clinical criterion in 3 (5.4%) studies, a mixture of clinical and parasitological methods in 47 (83.9%) and was unclear in 6 (10.7%) studies. Major drugs used for treatment were miltefosine (n = 636 patients), liposomal amphotericin B (L-AmB) (n = 508 patients), and antinomy regimens (n = 454 patients). Ten other drug regimens were tested in 270 patients with less than 60 patients per regimen.

Conclusions

Our review identified studies with very limited sample size for the three major drugs (miltefosine, L-AmB, and pentavalent antimony), while the number of patients combined across studies suggest that the IPD platform would be valuable. With the support of relevant stakeholders, the global PKDL community and sufficient financing, a PKDL IPD platform can be realised. This will allow for exploration of different aspects of treatment safety and efficacy, which can potentially guide future healthcare decisions and clinical practices.

Dr Emmanuelle Bitoun
Dr
Emmanuelle
Bitoun
Senior Operations and Development Manager
Research Theme
WWARN
Chagas
Schistosomiasis & STHs
Visceral leishmaniasis
Medicine quality
COVID19

Emmanuelle joined the Senior Management Team at IDDO in December 2023. As Senior Operations and Development Manager, she provides leadership to programme management and operations activity across IDDO’s portfolio of infectious disease research themes and data repository. She also oversees the governance of the organisation, and supports its strategic development including funding, communications and partnerships.

Emmanuelle has an MRes in Molecular and Cellular Immunology with a specialisation in Virology from University Paul Sabatier in Toulouse, France. She carried out a PhD in genetics at the WCHG in Oxford, developing the first prenatal diagnosis for a severe congenital immune and skin disorder. She then moved to the MRC Functional Genomics Unit, working in neurosciences on new therapeutic pathways for aggressive forms of blood cancer in children, before joining the Department of Statistics.

In the past 10 years, she managed the strategies, operations, and governance of multidisciplinary programmes in cancer and infertility across experimental and computational biology, including building and leading new research and preclinical validation platforms in academia and the industry.

Dr Lucie Kafkova
Dr
Lucie
Kafkova
Project Manager
Research Theme
Chagas
Visceral leishmaniasis

Lucie Kafkova, a former Marie Curie Postdoctoral Fellow, recently joined IDDO to support the Neglected Tropical Disease portfolio team. Before this, she conducted ground-breaking research in Prof. Mathew Freeman's lab at the Sir William Dunn School of Pathology, developing novel methodology using unnatural amino acids to discover new substrates of human rhomboid protease RHBDL4.

Lucie earned her Ph.D. at the University at Buffalo under the guidance of Prof. Laurie Read, investigating arginine methylation in Trypanosoma brucei. Her academic journey began with a master's and bachelor's degree in the lab of Prof. Lukes in the Czech Republic, where she studied RNA editing in Trypanosoma brucei. Notably, Lucie was honoured with the Dean's Prize for both her master's and Ph.D. theses. Lucie is also a certified Professional Coach, showcasing her commitment to personal and professional development.

 

Estimating the proportion of relapse following treatment of Visceral Leishmaniasis: meta-analysis using Infectious Diseases Data Observatory (IDDO) systematic review

The Lancet Regional Health - Southeast Asia
Published
6 Dec 2023
Authors
Rutuja Chhajed, Prabin Dahal, Sauman Singh-Phulgenda, Matthew Brack, Caitlin Naylor, Shyam Sundar, Fabiana Alves, Kasia Stepniewska, Philippe J. Guerin

Summary

Background

Occurrences of relapse after 6-months post-treatment has been reported in recent Visceral Leishmaniasis (VL) efficacy studies. A meta-analysis was carried out to quantify the proportion of relapses observed at and beyond 6-months using the Infectious Diseases Data Observatory (IDDO) systematic review (SR) database.

Methods

Studies in the IDDO SR database (1983–2021; 160 studies) were eligible for inclusion if follow-up was at least 6-months, relapse was clearly reported, and patients with HIV coinfections were excluded. Meta-analysis of single proportion was undertaken and the estimates were reported with 95% confidence intervals (CI).

Findings

Overall, 131 studies enrolling 27,687 patients were included; 1193 patients relapsed. In the Indian sub-continent (ISC), relapse estimates at 6-months was 4.5% [95% CI: 2.6%–7.5%; I2 = 66.2%] following single dose liposomal amphotericin B (L-AmB) and 1.5% [95% CI: 0.7%–3.3%; I2 = 0%] for L-AmB in a combination therapy. In East Africa (EA), corresponding estimates were 3.8% [95% CI: 1.3%–10.9%; I2 = 75.8%] following pentavalent antimony (PA), and 13.0% [95% CI: 4.3%–33.6%; I2 = 0%] for PA + paromomycin. From 21 studies with follow-up longer than 6-months, 0.6% [95% CI: 0.2%–1.8%; I2 = 0%] of patients relapsed after 6-months and estimated 27.6% [95% CI: 11.2%–53.4%; I2 = 12%] of relapses would have been missed by a 6-month follow-up.

Interpretation

The estimated relapse proportion ranged from 0.5% to 4.5% in ISC and 3.8%–13.0% in EA with the currently recommended drugs. Over one-quarter of relapses would be missed with 6-months follow-up suggesting a longer follow-up may be warranted.

Funding

Wellcome Trust (ref: 208378/Z/17/Z).

New meta-analysis finds six month follow-ups miss quarter of visceral leishmaniasis relapses

A meta-analysis of nearly 30,000 patients suggests that a post-treatment follow-up duration of longer than 6-months may be needed to identify visceral leishmaniasis relapses.

Photo of busy railway station in India

Visceral Leishmaniasis (also known as Kala Azar across the Indian subcontinent) is a protozoan parasitic disease which causes fever, weight loss, fatigue and anaemia. It is fatal in over 95% of the untreated cases, but the right treatment significantly reduces deaths and disease effects.

However, relapses after treatment, with clinical symptoms returning months later, remains a major public health concern. Quantifying these relapses is important to control the spread of the disease, so IDDO researchers in collaborations with colleagues working in the field undertook a large scale meta-analysis to generate a baseline estimate of relapses in patients who have been treated.  

The research team used the Infectious Diseases Data Observatory (IDDO)’s library of visceral leishmaniasis clinical studies: this library is a living systematic review updated on a periodic basis to indicate relevant publications indexed by major research databases in the field.

“We extracted data from the studies indexed in the IDDO’s library of visceral leishmaniasis clinical studies and analysed them to estimate the proportion of patients who showed signs of the disease returning after treatment had been completed,” said IDDO’s Dr Prabin Dahal, one of the study authors.

This analysis found that the rates of relapse varied widely, depending on where the patients lived and the exact drug regiment used for the treatment – between 0.5% and 4.5% of patients in the Indian subcontinent showed signs of the disease returning, but for East Africa, as many as 13% of the treated patients had recurring symptoms.

“Patients were also less likely to relapse after treatment with a combination of drugs, rather than single drug”, said IDDO’s Rutuja Chhajed, the study’s first author. The study also highlights previous work suggesting that a combination of drugs might work synergistically to reduce relapse rates as well as treatment duration for visceral leishmaniasis treatment, potentially helping to alleviate the burden on healthcare systems.

“21 of the studies we analysed followed up patients for longer than the standard six months, and based on these studies, we estimate that more than 27% of the relapses were being missed in the six month follow up,” said Dr Prabin Dahal. “Prompt identification and treatment of relapsing visceral leishmaniasis remains priority for the Kala Azar elimination programme in the Indian subcontinent and other regions as they provide an infective pool of the parasite to fuel disease transmission. We think that a longer follow-up duration is needed in future studies of visceral leishmaniasis to capture the late relapses, which remains crucial for disease control”.

Read the full paper in the Lancet Regional Health - SouthEast Asia

Find out more about our work on Visceral Leishmaniasis, and access our free database. 

Join IDDO’s team at ECTMIH 2023

IDDO and WWARN are delighted to be taking part in this year’s 13th European Congress on Tropical Medicine and International Health, (ECTMIH), and will be sharing our latest research across visceral leishmaniasis, malaria, medicine quality and lymphatic filariasis.

ECTMIH 2023 logo

This year’s meeting, in Utrecht, will focus on shaping the future of equitable and sustainable planetary health.

IDDO’s researchers will be presenting our latest research at a series of oral presentations and via e-posters.

Oral presentations

Tuesday, November 21

Join IDDO’s team at Tivoli Vredenburg Cloud Nine Track 2, from 10:30am (Central European Time CET), for a presentation on 'Safety and efficacy of primaquine in patients with P. vivax malaria from South Asia: A systematic review and individual patient data meta-analysis'

Thursday, November 23

Watch two presentations on visceral leishmaniasis on, at the Social Impact Factory Room 3, from 10.30am CET

  • Host, parasite and drug determinants of treatment outcomes in Visceral Leishmaniasis: An individual patient data meta-analysis using the Infectious Diseases Data Observatory data platform
  • Haemoglobin dynamics following treatment of Visceral Leishmaniasis: An individual patient data meta-analysis using the Infectious Diseases Data Observatory data platform

Join IDDO at 3.30pm CET in the Tivoli Vredenburg Hertz, Track 2, for our presentation ‘Systematic review and geospatial modelling of molecular markers of resistance to artemisinins and sulfadoxine-pyrimethamine in Plasmodium falciparum in India'

 

Posters

  • Ophthalmological Complications in Visceral Leishmaniasis and Post Kala-Azar Dermal Leishmaniasis: A Systematic Review of Published Literature
  • Lymphatic filariasis treatment studies: the case for an individual participant-level data platform
  • Navigating the Neglected Crystal Ball: A Systematic Review of Prognostic Models in Visceral Leishmaniasis
  • Substandard and falsified vaccines and their detection

 

ECTMIH, which takes place from November 23 to 23, provides a platform for experts, scientists and researchers to present scientific developments and breakthroughs in tropical medicine and global health, and strengthens networks and creates new partnerships.

If you are not able to join us in-person then why not follow what is happening at the conference over Twitter by following us on @IDDOnews

Read our latest news or email info@iddo.org with your questions.

 

IDDO and WWARN Director receives ASTMH medal

Professor Philippe Guérin, IDDO and WWARN’s Director, has been awarded the Bailey K. Ashford Medal for his “distinguished” work in tropical medicine.

Philippe Guerin receives medal

The American Society for Tropical Medicine and Hygiene (ASTMH ) President Daniel G. Bausch presented the medal at a ceremony at the Hyatt Regency Chicago, on the opening day of the 72nd annual meeting of the society

Professor Guérin was nominated for the award by Dr Abib Abera, of Addis Ababa University (AAU), Ethiopia, to mark his 25-year career in the field of tropical medicine where he has led research in clinical trials and epidemiology to improve outcomes for some of the world’s most vulnerable populations.

He began his career as a physician working in France and Nepal, before joining Médecins Sans Frontières where he worked in the field in many countries in Africa and Asia. He later moved into research and held a number of posts with the Wellcome Trust Oxford Research Unit in Thailand, the Department of Infectious Disease Epidemiology at the Norwegian Institute of Public Health, and Épicentre in Paris - a World Health Organization (WHO) Collaborating Centre for Research in epidemiology and response to emerging diseases.

Philippe’s interest lay in research and how data could be better used to further research. He has been the director of the WorldWide Antimalarial Network (WWARN) since its inception. WWARN is a collaborative data platform generating innovative resources and reliable evidence to inform the malaria community on the factors affecting the efficacy of antimalarial medicines. In 2016, Philippe established the Infectious Diseases Data Observatory (IDDO), focusing on neglected tropical diseases and emerging infections to provide an environment for equitable sharing of data, methods and infrastructure to generate evidence that improves outcomes for patients worldwide.

The Bailey K. Ashford Medal is named in honour of Bailey K. Ashford who recognised the connection between hookworm infection and anaemia at the age of 26.

Philippe said “I am thrilled to be awarded this medal, which is more of a recognition of the hard work of the very many people I have worked with throughout my career.”

 

Dr Farhad Shokraneh
Dr
Farhad
Shokraneh
Evidence Synthesis Manager
Research Theme
Malaria
Visceral leishmaniasis
COVID19
Schistosomiasis & STHs
Chagas
WWARN

Dr Farhad Shokraneh has 20 years of experience and a PhD in Evidence Synthesis. He joined IDDO in October 2023 as Evidence Synthesis Manager.

Previously, he has worked at the University of Nottingham, King's College London, University College London, UCLH, and Cambridge University in similar roles. He has led teams to deliver projects to clients such as WHO, UN, UNICEF, FDA, UK NIHR, Cochrane, AWMF, and NICE.

As a passionate methodologist and change maker, Farhad is a co-author of the Cochrane Handbook, an editor of Systematic Reviews journal and has designed the first and most sensitive search strategy for COVID-19 literature and the first living search strategy and coined concepts such as 'Search-Resistant Concepts', 'Search Pyramid', 'Living Search Strategy', and 'Iterative Systematic Reviews'.

Dr Charvy Narain
Dr
Charvy
Narain
Communications Manager
Research Theme
Malaria
Visceral leishmaniasis
COVID19
Schistosomiasis & STHs
Chagas
Medicine quality
Antimicrobial resistance
WWARN

Dr Charvy Narain holds a doctorate in Neurosciences from the University of Oxford, and has worked in research communications for over 15 years. In her currently role as Communications Manager for IDDO, she provides strategic communications advice and implements IDDO's communications strategy across various communications channels, including the IDDO website and social media. She also line manages the IDDO communications officer.