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Update on field use of the available drugs for the chemotherapy of human African trypanosomiasis

Published online by Cambridge University Press:  06 February 2012

P. P. SIMARRO ,
J. FRANCO ,
A. DIARRA ,
J. A. RUIZ POSTIGO  and
J. JANNIN
P. P. SIMARRO*
Affiliation:
World Health Organization, HTM/NTD 20, avenue Appia 1211, Geneva 27, Switzerland
J. FRANCO
Affiliation:
World Health Organization, HTM/NTD 20, avenue Appia 1211, Geneva 27, Switzerland
A. DIARRA
Affiliation:
World Health Organization, IST/CA, P.O. Box 820, Libreville, Gabon
J. A. RUIZ POSTIGO
Affiliation:
World Health Organization, CTD/DCD, P.O. Box3: 7608, Nasr City, Cairo 11371, Egypt
J. JANNIN
Affiliation:
World Health Organization, HTM/NTD 20, avenue Appia 1211, Geneva 27, Switzerland
*
*Corresponding author: HTM/NTD, 20, avenue Appia 1211 Geneva 27, Switzerland. Tel: +41 22 791 1345. Fax: +41 22 791 4777. E-mail: simarrop@who.int
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Summary

Despite the fact that eflornithine was considered as the safer drug to treat human African trypanosomiasis (HAT) and has been freely available since 2001, the difficulties in logistics and cost burden associated with this drug meant that the toxic melarsoprol remained the drug of choice. The World Health Organization responded to the situation by designing a medical kit containing all the materials needed to use eflornithine, and by implementing a training and drugs distribution programme which has allowed a transition to this much safer treatment. The introduction of the combination of nifurtimox and eflornithine (NECT) has accelerated the shift from melarsoprol to the best treatment available, due to reduced dosage and treatment time for eflornithine that has significantly lessened the cost and improved the burden of logistics encountered during treatment and distribution. The decrease in the use of more dangerous but cheaper melarsoprol has meant a rise in the per patient cost of treating HAT. Although NECT is cheaper than eflornithine monotherapy, an unexpected consequence has been a continuing rise in the per patient cost of treating HAT. The ethical decision of shifting to the best available treatment imposes a financial burden on HAT control programmes that might render long-term application unsustainable. These factors call for continuing research to provide new safer and more effective drugs that are simple to administer and cheaper when compared to current drugs.

Keywords

African trypanosomiasismelarsoproleflornithinenifurtimoxtreatment combinations
Type
Review Article
Information
Parasitology , Volume 139 , Issue 7 , June 2012 , pp. 842 - 846
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

Balasegaram, M., Harris, S., Checchi, F., Ghorashian, S., Hamel, C. and Karunakara, U. (2006). Melarsoprol versus eflornithine for treating late-stage Gambian trypanosomiasis in the Republic of the Congo. Bulletin of the World Health Organization 84, 783–791.CrossRefGoogle ScholarPubMed
Bisser, S., N'siesi, F. X., Lejon, V., Preux, P. M., Van Nieuwenhove, S., Miaka Mia Bilenge, C. and Buscher, P. (2007). Equivalence trial of melarsoprol and nifurtimox monotherapy and combination therapy for the treatment of second-stage Trypanosoma brucei gambiense sleeping sickness. Journal of Infectious Diseases 195, 322–329.CrossRefGoogle ScholarPubMed
Blum, J., Nkunku, S. and Burri, C. (2001). Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis. Tropical Medicine and International Health 6, 390–400.CrossRefGoogle ScholarPubMed
Burri, C. (2010). Chemotherapy against human African trypanosomiasis: Is there a road of success ? Parasitology 137, 1987–1994.CrossRefGoogle Scholar
Chappuis, F., Udayraj, N., Stietenroth, K., Meussen, A. and Bovier, P. A. (2005). Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis. Clinical Infectious Diseases 41, 748–751.CrossRefGoogle ScholarPubMed
Checchi, F., Piola, P., Ayikoru, H., Thomas, F., Legros, D. and Priotto, G. (2007). Nifurtimox plus eflornithine for late-stage sleeping sickness in Uganda: a case series. PLoS Neglected Tropical Diseases 1, e64.CrossRefGoogle ScholarPubMed
Janssens, P. G. and De Muynck, A. (1977). Clinical trials with “nifurtimox” in African trypanosomiasis. Annales Societé Belge Médicine Tropicale 57, 475–480.Google Scholar
Legros, D., Evans, S., Maiso, F., Eyaru, J. C. K. and Mbulamberi, D. (1999). Risk factors for treatment failure after melarsoprol for Trypanosoma brucei gambiense trypanosomiasis in Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 93, 439–442.CrossRefGoogle ScholarPubMed
Moens, F., De Wilde, M. and Ngato, K. (1984). Clinical trial of nifurtimox in human African trypanosomiasis. Annales Societé Belge Médicine Tropicale 64, 37–43.Google ScholarPubMed
Moore, A. C. (2005). Prospects for improving African trypanosomiasis chemotherapy. The Journal of Infectious Diseases 191, 1793–1795.CrossRefGoogle ScholarPubMed
Pepin, J., Milord, F., Meurice, F., Ethier, L., Loko, L. and Mpia, B. (1992). High-dose nifurtimox for arseno-resistant Trypanosoma brucei gambiense sleeping sickness: an open trial in central Zaire. Transactions of the Royal Society of Tropical Medicine and Hygiene 86, 254–256.CrossRefGoogle ScholarPubMed
Priotto, G., Fogg, C., Balasegaram, M., Erphas, O., Louga, A., Checchi, F., Ghabri, S. and Piola, P. (2006). Three drug combinations for late-stage Trypanosoma brucei gambiense sleeping sickness: A randomized clinical trial in Uganda. PLoS Clinical Trials 1, e39: 31–38.CrossRefGoogle ScholarPubMed
Priotto, G., Kasparian, S., Mutombo, W., Ngouama, D., Ghorashian, S., Arnold, U., Ghabri, S., Baudin, E., Buard, V., Kazadi-Kyanza, S., Ilunga, M., Mutangala, W., Pohlig, G., Schmid, C., Karunakara, U., Torreele, E. and Kande, V. (2009). Nifurtimox-eflornithine combination therapy for second-stage African Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomised, phase III, non-inferiority trial. Lancet 374, 56–64.CrossRefGoogle ScholarPubMed
Priotto, G., Pinoges, L., Badi Fursa, I., Burke, B., Nicolay, N., Grillet, G., Hewison, C. and Balasegaram, M. (2008). Safety and effectiveness of first line eflornithine for Trypanosoma brucei gambiense sleeping sickness in Sudan. British Medical Journal 336, 705–708.CrossRefGoogle ScholarPubMed
Robays, J., Raguenaud, M. E., Josenando, T. and Boelaert, M. (2008). Eflornithine is a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito, Angola. Tropical Medicine and International Health 13, 265–271.CrossRefGoogle ScholarPubMed
Seixas, J. (2004). Investigations on the encephalopathic syndrome during melarsoprol treatment of human African trypanosomiasis. Ph.D. thesis, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa.Google Scholar
Simarro, P. P., Diarra, A., Ruiz Postigo, J. A., Franco, J. R. and Jannin, J. G. (2011). The Human African Trypanosomiasis Control and Surveillance Programme of the World Health Organization 2000–2009: The Way Forward. PLoS Neglected Tropical Diseases 5, e1007. doi: 10.1371/journal.pntd.0001007.CrossRefGoogle ScholarPubMed
Van Nieuwenhove, S. (2000). Gambiense sleeping sickness: re-emerging and soon untreatable? Bulletin of the World Health Organization 78, 1283.Google ScholarPubMed
Vincent, I. M., Creek, D., Watson, D. G., Kamleh, M. A., Woods, D. J., Pui EeWong, P. E., Burchmore, R. J. S. and Barrett, M. P. (2010). A Molecular Mechanism for Eflornithine Resistance in African Trypanosomes. PLoS Pathogens 6, e1001204. doi: 10.1371/journal.ppat.1001204.CrossRefGoogle ScholarPubMed
World Health Organization (2009). WHO model list of essential medicines, 16th list March 2009. World Health Organization, Geneva, Switzerland. http://www.who.int/medicines/publications/essentialmedicines/en/index.html.Google Scholar