Emerging treatments
Nitroimidazoles
Fexinidazole is a nitroimidazole used to treat African trypanosomiasis that has shown potent activity against Leishmania donovani. Unfortunately, in a phase 2 study in Sudan, despite initial clearance in most patients, only 21% were cured at 6 months. It is possible that future studies looking at a combination of fexinidazole and miltefosine may be done.[187] Other nitroimidazoles (e.g., DNDi-0690, pretomanid, delamanid) show in vitro and/or in vivo activity against Leishmania parasites, and DNDi-0690 has been tested in a phase 1 trial.[188][189]
Novel drug candidates
In addition to DNDi-0690, the Drugs for Neglected Diseases initiative (DNDi) is moving other novel drug candidates into early clinical development.[190] GSK3186899 is a novel compound that DNDi is supporting in ongoing phase 1 studies in the UK.[191] DNDi-6148 is an oxaborole compound (chosen from among three similar compounds) that is planned to progress into phase 1 studies. LXE408 is a proteasome inhibitor planned for a phase 2 trial in India.[192][193] CpG-D35 is an immunomodulator theorised to stimulate an innate immune response, as an adjuvant to treatment with antimonials in cutaneous leishmaniasis.
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