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Lutje, Vittoria; Seixas, Jorge; Kennedy, Adrian (2010)
Publisher: John Wiley & Sons, Ltd.
Languages: English
Types: Article
Subjects: wc_705, wb_330
Background\ud Human African trypanosomiasis, or sleeping sickness, is a painful and protracted disease affecting people in the poorest parts of Africa and is fatal without treatment. Few drugs are currently available for second-stage sleeping sickness, with considerable adverse events and variable efficacy.\ud \ud Objectives\ud To evaluate the effectiveness and safety of drugs for treating second-stage human African trypanosomiasis.\ud \ud Search methods\ud We searched the Cochrane Infectious Diseases Group Specialized Register (May 2010), CENTRAL (The Cochrane Library Issue 3 2010) , MEDLINE (1966 to May 2010), EMBASE (1974 to May 2010), LILACS (1982 to May 2010 ), BIOSIS (1926-May 2010), mRCT (May 2010) and reference lists. We contacted researchers working in the field and organizations.\ud \ud Selection criteria\ud Randomized and quasi-randomized controlled trials.\ud Data collection and analysis\ud Two authors (VL and AK) extracted data and assessed methodological quality; a third author (JS) acted as an arbitrator. Included trials only reported dichotomous outcomes, and we present these as risk ratio (RR) with 95% confidence intervals (CI).\ud \ud Main results\ud Nine trials with 2577 participants, all with Trypansoma brucei gambiense HAT, were included. Seven trials tested currently available drugs: melarsoprol, eflornithine, nifurtimox, alone or in combination; one trial tested pentamidine, and one trial assessed the addition of prednisolone to melarsoprol. Fixed 10-day regimens of melarsoprol were found to be as effective as those of 26 days, with similar numbers of adverse events. Melarsoprol monotherapy gave fewer relapses than pentamidine or nifurtimox, but resulted in more adverse events.\ud Later trials evaluate nifurtimox combined with eflornithine (NECT), showing this gives few relapses and is well tolerated. It also has practical advantages in reducing the burden on health personnel and patients, when compared to eflornithine monotherapy.\ud \ud Authors' conclusions\ud Choice of therapy for second stage Gambiense HAT will continue to be determined by what is locally available, but eflornithine and NECT are likely to replace melarsoprol, with careful parasite resistance monitoring. We need research on reducing adverse effects of currently used drugs, testing different regimens, and experimental and clinical studies of new compounds, effective for both stages of the disease.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • Standard melarsoprol Bisser 2007 3.6 mg vs nifurtimox 14 days
    • 4.8. Melarsoprol-eflornithine versus melarsoprol-nifurtimox Bisser 2007 {published data only} Bisser S, N'Siesi FX, Lejon V, Preux PM, Van Nieuwenhove S, Miaka Mia Bilenge C, et al.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 2007; Vol. 195, issue 3: 322-9.
    • Burri 2000 {published data only} Burri C, Nkunku S, Merolle A, Smith T, Blum J, Brun R. Efficacy of new, concise schedule for melarsoprol in treatment of sleeping sickness caused by Trypanosoma brucei gambiense: a randomised trial. Lancet 2000; Vol. 355, issue 9213:1419-25. Schmid C, Nkunku S, Merolle A, Vounatsou P, Burri C. Efficacy of 10-day melarsoprol schedule 2 years after treatment for late-stage gambiense sleeping sickness. Lancet 2004;364(9436):789-90.
    • Lejon 2003 {published data only} Legros D, Erphas O, Priotto G, Hutin Y, Mbulamberi DB, Gastellu Etchegorry M, et al.[Essai clinique randomise ouvert comparant le melarsoprol a la pentamidine pour le traitment des patients souffrant de trypanosomiase a Trypanosoma brucei gambiense en stade 2 precoce en Ouganda]. Medecine Tropicale 2001;61(3):278. Lejon V, Legros D, Savignoni A, Etchegorry MG, Mbulamberi D, Buscher P. Neuro-inflammatory risk factors for treatment failure in “early second stage” sleeping sickness patients treated with pentamidine. Journal of Neuroimmunology 2003; Vol. 144, issue 1-2:132-8.
    • Na-Bangchang 2004 {published data only} Na-Bangchang K, Doua F, Konsil J, Hanpitakpong W, Kamanikom B, Kuzoe F. The pharmacokinetics of eflornithine (alphadifluoromethylornithine) in patients with late-stage T.b. gambiense sleeping sickness. European Journal of Clinical Pharmacology 2004; Vol. 60, issue 4:269-78.
    • Pepin 1989a {published data only} Pepin J, Milord F, Guern C, Mpia B, Ethier L, Mansinsa D. Trial of prednisolone for prevention of melarsoprol-induced encephalopathy in gambiense sleeping sickness. Lancet 1989; Vol. 1, issue 8649:1246-50.
    • Pepin 2000 {published data only} Pepin J, Khonde N, Maiso F, Doua F, Jaffar S, Ngampo S, et al.Short-course eflornithine in Gambian trypanosomiasis: a multicentre randomized controlled trial. Bulletin of the World Health Organization 2000; Vol. 78, issue 11:1284-95.
    • Pepin 2006 {published data only} Pepin J, Mpia B. Randomized controlled trial of three regimens of melarsoprol in the treatment of Trypanosoma brucei gambiense D A T A A N A L Y S E S 1 or 2 or 3 C O N T R I B U T I O N S O F I N T E R E S T
  • No related research data.
  • Discovered through pilot similarity algorithms. Send us your feedback.

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