• Eflornithine is Safer Than Melarsoprol for the Treatment of Second-Stage Trypanosoma Brucei Gambiense Human African Trypanosomiasis.

      Chappuis, F; Udayraj, N; Stietenroth, K; Meussen, A; Bovier, P A; Médecins Sans Frontières, Geneva University Hospitals, Geneva, Switzerland. francois.chappuis@hcuge.ch (Published by: Infectious Diseases Society of America, 2005-09-01)
      Patients with second-stage human African trypanosomiasis treated with eflornithine (n = 251) in 2003 in Kiri, southern Sudan, had an adjusted relative risk of death of 0.2 and experienced significantly fewer cutaneous and neurological adverse effects than did patients who were treated with melarsoprol in 2001 and 2002 (n = 708).
    • Melarsoprol-Free Drug Combinations for Second-Stage Gambian Sleeping Sickness: The Way to Go.

      Chappuis, F; Travel and Migration Medicine Unit, Geneva University Hospital, and Medecins Sans Frontieres, Swiss Section, 1202 Geneva, Switzerland. francois.chappuis@hcuge.ch (Published by: Infectious Diseases Society of America, 2007-12-01)
    • Nifurtimox-Eflornithine Combination Therapy for Second-stage Gambiense Human African Trypanosomiasis: Médecins Sans Frontières experience in the Democratic Republic of the Congo

      Alirol, E; Schrumpf, D; Amici Heradi, J; Riedel, A; de Patoul, C; Quere, M; Chappuis, F; Division of International and Humanitarian Medicine, University Hospitals of Geneva, Switzerland. emilie.alirol@hcuge.ch (Oxford University Press, 2012-11-09)
      Existing diagnostic and treatment tools for human African trypanosomiasis (HAT) are limited. The recent development of nifurtimox-eflornithine combination therapy (NECT) has brought new hopes for patients in the second stage. While NECT has been rolled out in most endemic countries, safety data are scarce and derive only from clinical trials. The World Health Organization (WHO) coordinates a pharmacovigilance program to collect additional data on NECT safety and efficacy. We report here the results of 18 months of experience of NECT use in treatment centers run by Médecins Sans Frontières in the Democratic Republic of the Congo (DRC).
    • Nifurtimox-eflornithine Combination Therapy for Second-Stage Trypanosoma Brucei Gambiense Sleeping Sickness: A Randomized Clinical Trial in Congo.

      Priotto, G; Kasparian, S; Ngouama, D; Ghorashian, S; Arnold, U; Ghabri, S; Karunakara, U; Epicentre, Paris, France. gpriotto@epicentre.msf.org (Published by: Infectious Diseases Society of America, 2007-12-01)
      BACKGROUND: Human African trypanosomiasis caused by Trypanosoma brucei gambiense is a fatal disease. Current treatment options for patients with second-stage disease are either highly toxic or impracticable in field conditions. We compared the efficacy and safety of the nifurtimox-eflornithine drug combination with the standard eflornithine regimen for the treatment of second-stage disease. METHODS: A randomized, open-label, active-control, phase III clinical trial comparing 2 arms was conducted at the Sleeping Sickness Treatment Center, which was run by Medecins Sans Frontieres, in Nkayi, Bouenza Province, Republic of Congo. Patients were screened for inclusion and randomly assigned to receive eflornithine alone (400 mg/kg per day given intravenously every 6 h for 14 days) or eflornithine (400 mg/kg per day given intravenously every 12 h for 7 days) plus nifurtimox (15 mg/kg per day given orally every 8 h for 10 days). Patients were observed for 18 months. The study's outcomes were cure and adverse events attributable to treatment. RESULTS: A total of 103 patients with second-stage disease were enrolled. Cure rates were 94.1% for the eflornithine group and 96.2% for the nifurtimox-eflornithine group. Drug reactions were frequent in both arms, and severe reactions affected 25.5% of patients in the eflornithine group and 9.6% of those in the nifurtimox-eflornithine group, resulting in 2 and 1 treatment suspensions, respectively. There was 1 death in the eflornithine arm and no deaths in the nifurtimox-eflornithine arm. CONCLUSIONS: The nifurtimox-eflornithine combination appears to be a promising first-line therapy for second-stage sleeping sickness. If our findings are corroborated by ongoing findings from additional sites (a multicenter extension of this study), the new nifurtimox-eflornithine combination therapy will mark a major and multifaceted advance over current therapies.