long slog. In Uganda patient is treated with eflornithine, which requires intravenous infusion every 6 hours for 14 days.
Andy Crump / WHO
NEW ORLEANS, LOUISIANA - This is far from the ideal therapy, but scientists say a new combination of two old drugs is an important step in the fight against sleeping sickness, a long neglected tropical disease. They hope the combo will help reduce the use of a 60-year-old drug, highly toxic killing a patient 20.
Sleeping sickness, caused by two subspecies of Trypanosoma brucei unicellular parasite and transmitted by the tsetse fly, affects approximately 50,000 to 70,000 people a year in Africa. In the later stages of infection, parasites not only disrupt the sleep cycle, but also cause paralysis, behavioral changes, and ultimately death. That's why scientists find the common name a little too innocuous sounding; they usually call the affliction of human African trypanosomiasis (HAT).
Among the few existing drugs that fight HAT, none are very good. An originally developed for cancer drug called eflornithine, kills Trypanosoma and is reasonably safe, but parasites are increasingly resistant. In addition, patients need intravenous 56 (IV) infusions of more than 14 days, a huge problem in developing countries. (The simple drug weight and other necessary materials makes eflornithine very expensive to ship and says Pere Simarro of the World Health Organization.) Consequently, 70% of patients in 07 were always treated with melarsoprol a compound based arsenic developed in the 1940s which is very toxic.
an international consortium of researchers tested a new treatment in the Democratic Republic of Congo and its neighbor, the Republic of Congo. They enrolled 280 patients in a trial that compared standard eflornithine regime with one where only 14 injections of the drug were given on time a week, combined with 10 days of nifurtimox, an oral drug against licensed Chagas disease - which is also caused by Trypanosoma parasites -. but are not considered active enough as a standalone HAT drug
Find, treat and monitor patients in the most remote corners of the two countries has proved a huge challenge, said Gerardo Priotto, an epidemiologist with Médecins Sans borders in Paris. To ensure that patients were truly free of the parasite, for example, they had to be persuaded to go to the clinic of the study and undergo painful lumbar punctures 6, 12, and 18 months after the trial - which is not easy when patients no longer feel sick.
But it was worth it. The combination works at least as well as eflornithine or melarsoprol alone, researchers reported yesterday at the annual meeting of the American Society of Tropical Medicine and Hygiene. And there were fewer side effects. This is an important step, said Peter Hotez, who studies the THA and other tropical diseases at the Medical Center of George Washington University in Washington State two drugs rather than one should help prevent resistance, he said . And because 14 instead of 56 infusions of eflornithine are needed, the combination should help reduce the use of melarsoprol.
However, better and cheaper drugs that remove the need for infusions in total are desperately needed, said Simon Croft of London School for Hygiene and Tropical Medicine. Thank you to a recent influx of money on the ground, several are now in the pipeline; combination therapy, said Croft, "will finally be no more than a stopgap."
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