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Effectiveness of melarsoprol and eflornithine as first-line regimens for gambiense sleeping sickness in nine Médecins Sans Frontières programmes

Balasegaram, Manica ; Young, Heather ; Chappuis, François ; Priotto, Gerardo ; Raguenaud, Marie-Eve ; Checchi, Francesco

In: Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009, vol. 103, no. 3, p. 280-290

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    Titre
    • Effectiveness of melarsoprol and eflornithine as first-line regimens for gambiense sleeping sickness in nine Médecins Sans Frontières programmes
    Auteur
    • Balasegaram, Manica. Médecins Sans Frontières—United Kingdom, 67-74 Saffron Hill, London EC1N 8QX, UK
    • Young, Heather. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
    • Chappuis, François. Médecins Sans Frontières—Swiss Section, 78 rue de Lausanne, 1211 Geneva 21, Switzerland
    • Priotto, Gerardo. Epicentre, 8 rue Saint-Sabin, 75011 Paris, France
    • Raguenaud, Marie-Eve. Médecins Sans FrontièresȄBelgian Section, Dupréstraat 94, 1090 Brussels, Belgium
    • Checchi, Francesco. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009, vol. 103, no. 3, p. 280-290. Royal Society of Tropical Medicine and Hygiene
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:296650
    Summary
    This paper describes the effectiveness of first-line regimens for stage 2 human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense infection in nine Médecins Sans Frontières HAT treatment programmes in Angola, Republic of Congo, Sudan and Uganda. Regimens included eflornithine and standard- and short-course melarsoprol. Outcomes for 10461 naïve stage 2 patients fitting a standardised case definition and allocated to one of the above regimens were analysed by intention-to-treat analysis. Effectiveness was quantified by the case fatality rate (CFR) during treatment, the proportion probably and definitely cured and the Kaplan-Meier probability of relapse-free survival at 12 months and 24 months post admission. The CFR was similar for the standard- and short-course melarsoprol regimens (4.9% and 4.2%, respectively). The CFR for eflornithine was 1.2%. Kaplan-Meier survival probabilities varied from 71.4-91.8% at 1 year and 56.5-87.9% at 2 years for standard-course melarsoprol, to 73.0-91.1% at 1 year for short-course melarsoprol, and 79.9-97.4% at 1 year and 68.6-93.7% at 2 years for eflornithine. With the exception of one programme, survival at 12 months was >90% for eflornithine, whilst for melarsoprol it was <90% except in two sites. Eflornithine is recommended where feasible, especially in areas with low melarsoprol effectiveness