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Journal of Postgraduate Medicine, Vol. 51, No. 5s1 , 2005, pp. 3 Editorial Editorial Note Kshirsagar NA, Pandya SK* Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel and *Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel dcpkem@vsnl.com Correspondence Address: N. A. Kshirsagar, E-mail: dcpkem@vsnl.com Code Number: jp05124 Development of new drug molecules is expensive and time consuming. Improving safety and efficacy ratio of "old" drugs is achieved by individualizing drug therapy, dose titration and therapeutic drug monitoring. Amongst various carrier systems, liposomes have generated a great interest because of their versatility. Dr. B.K. Bacchawat was remarkably farsighted. He recognized the potential of liposomes in therapy in the mid-1980s and set up his pioneering laboratory in New Delhi. The development of the technique in India for preparing liposomes, successfully encapsulating amphotericin within them and proving the efficacy of this preparation in clinical practice owes much to him. Both of us had the good fortune of interacting with him and were thrilled when he offered us the fruits of his labors in the laboratory for use in clinical medicine. He pointed out to us that once this technique was perfected, other drugs could be similarly incorporated into liposomes. Under his guidance and with his encouragement, we set up a liposome research laboratory in Seth G.S. Medical College and K.E.M. Hospital. The progress was slow but sure and by 1993 we were able to report on the pharmacological and preclinical tests of our product (Gokhale et al 1993). Our liposomal amphotericin B has been used not only in the treatment of life-threatening systemic fungal infection but also in the treatment of leishmaniasis, especially in patients in whom conventional drugs prove ineffective. Our paper on Indian liposomal preparation reviews our work, the publications that flowed from it and attempts to compare the efficacy and benefits of our product for Indian patients with those of other similar products. The cost of any drug is of great significance, especially in India. We have therefore devoted a section of our review to the relative costs of our product and those of other commercially available products to our patients. Once the efficacy and safety of our liposomal Amphotericin had been proven in a statistically significant number of patients, we attempted to transfer our technology from laboratory to large scale production and distribution. Our experiences may help others reduce the inordinate delay in such transfer. As predicted by Dr. Bacchawat, we have now turned our attention to alternative routes for the administration of liposomes and to other drugs that can be delivered via liposomes. A brief review of this work is also provided. This supplement highlights various aspects including the microbiology of fungal infections by Dr Arunaloke Chakrabarti, clinical features, management and role of liposomal amphotericin B in the management of leishmaniasis and systemic fungal infections in various types of patients. This is ably handled by Dr Dillip Mathai (CMC Vellore), Dr Purvish Parikh (TMH, Mumbai), Dr Atul Goel (GSMC and KEMH, Mumbai) Dr Atul Sharma (IRCH, AIIMS, New Delhi). Dr Shyam Sundar, (Institute of Medical Sciences, Varanasi), Dr B V Gandhi (Jaslok Hospital, Mumbai) and Dr Uma Ali (BJ Wadia Children Hospital, Mumbai). Paper by Sanath et al is a compilation of data from postmarketing study of the marketed liposomal amphotericin B (FungisomeTM). It also highlights the real life efficacy safety and cost advantage of this preparation. The supplement, we hope would be useful to those physicians, surgeons and oncologists who deal with patients with systemic fungal infections and leishmaniasis. Supplement would be useful to those who will use Fungisome, (Indian liposomal amphotericin) , as our and others experience on development and use of this drug is reviewed. We would like to acknowledge DBT and DSIR/ PATSER/ for their financial assistance in the development of this drug and in publishing this supplement. We also hope that users in other countries would be benefited by this supplement. Copyright 2005 - Journal of Postgraduate Medicine |
