Chemotherapy for second-stage Human African trypanosomiasis

Lutje, Vittoria, Seixas, Jorge and Kennedy, Adrian (2013) 'Chemotherapy for second-stage Human African trypanosomiasis'. Cochrane Database of Systematic Reviews, Vol 6, CD006201.

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Abstract

Background

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.

Objectives

To evaluate the effectiveness and safety of drugs for treating second-stage human African trypanosomiasis.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (January 2013), CENTRAL (The Cochrane Library Issue 12 2012) , MEDLINE (1966 to January 2013), EMBASE (1974 to January 2013), LILACS (1982 to January 2013 ), BIOSIS (1926-January 2013), mRCT (January 2013) and reference lists. We contacted researchers working in the field and organizations.

Selection criteria

Randomized and quasi-randomized controlled trials including adults and children with second-stage HAT, treated with anti-trypanosomal drugs.

Data collection and analysis

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).

Main results

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. The frequency of death and number of adverse events were similar between patients treated with fixed 10-day regimens of melarsoprol or 26-days regimens. Melarsoprol monotherapy gave fewer relapses than pentamidine or nifurtimox, but resulted in more adverse events.

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 frequency and number of eflornithine slow infusions to twice a day, thus easing the burden on health personnel and patients.

Item Type:	Article
Additional Information:	This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2013, Issue 6. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’
Subjects:	QV Pharmacology > QV 38 Drug action. WB Practice of Medicine > Therapeutics > WB 330 Drug therapy WC Communicable Diseases > Tropical and Parasitic Diseases > WC 705 Trypanosomiasis WC Communicable Diseases > Tropical and Parasitic Diseases > WC 770 Therapy
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1002/14651858.CD006201.pub3
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	19 Nov 2014 09:50
Last Modified:	06 Feb 2018 13:08
URI:	https://archive.lstmed.ac.uk/id/eprint/4591

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