Neglected tropical diseases

Improving access to the best treatment for second stage T.b.gambiense

WHO presentation at 6th European Congress on Tropical Medicine and International Health,
6–10 September 2009, Verona, Italy.

11 September 2009, Geneva

The World Health Organization (WHO) has released figures that show a remarkable increase in the treatment by eflornithine of the second stage of the Gambiense form of human African trypanosomiasis (HAT). The success is attributed to capacity building and the free distribution of an eflornithine kit since 2006, aimed at facilitating the administration of the drug.

Data presented during the 6th European Congress on Tropical Medicine in Verona, Italy show that the use of melarsoprol, the other commonly used drug in the second stage treatment of HAT, has declined from 88% in 2006 to 51% in 2008.

Treatment drugs
The Gambiense form of human African trypanosomiasis accounts for more than 95% of all cases reported on the African Continent. To treat the second stage of the disease, two drugs are available, namely Melarsoprol and eflornithine. Melarsoprol is an arsenic derivate drug with very severe adverse effects, administered during 10 days by one single intravenous injection per day.

The other drug, eflornithine, an ornithine derivate drug which also presents adverse effects, is much better tolerated than melarsoprol.

Eflornithine has been considered as the best option to treat the second stage of the Gambiense form of HAT. The principal constraint in using this drug is that it is cumbersome and expensive to administer. Eflornithine needs to be diluted and given during 14 days with 4 intravenous perfusions per day. The solvents and equipment needed are heavy, expensive and difficult to obtain in rural settings where the disease is prevalent. For those reasons, and until recently, only non-governmental organizations were able to afford to use eflornithine and offer it as the best treatment option. At one point, national HAT control programmes represented less than 5% eflornithine users, compared with 63% today.

By contrast, melarsoprol, despite its severe side-effects had, until recently, been the most frequently used drug (up to 88%) due to simple logistic requirements and the need for less skilled-staff to administer the drug.

Turning point
In 2006, the main disease-endemic countries requested support from WHO to include eflornithine as a first line drug for the treatment of second stage of the Gambiense form of HAT.

Within the framework of a Public-Private Partnership with the French pharmaceutical company, sanofi-aventis, WHO organized training courses for key staff involved in case management, who passed on the skills to other field staff. WHO also designed and distributed, in collaboration with MSF-Logistics, an eflornithine kit which included all the materials needed to administer the drug.

Better treatment prospects
With the inclusion in April 2009 of the nifurtimox-eflornithine combination treatment (NECT) in the WHO Essential List of Medicines, disease-endemic countries now have a new opportunity and a less complex option to treat the second stage of the Gambiense form of HAT.

WHO has now designed a new NECT-kit to facilitate its use. It is expected that the positive results on the current improvement on the use of eflornithine will facilitate the inclusion of this combination therapy in national policies and facilitate its implementation.

For more details, see The disease

For more information, please contact:
Dr. Pere Perez Simarro
simarrop@who.int
Mobile: +41 79 468 2726

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