Bokelo Mpia1, Jacques Pépin. 1. Hôpital de Nioki, Nioki, Democratic Republic of Congo. jpepin01@courrier.usherb.ca
Abstract
OBJECTIVE: To evaluate the efficacy and toxicity of a combination of eflornithine and melarsoprol among relapsing cases of Gambian trypanosomiasis. METHODS: Forty-two late-stage Trypanosoma brucei gambiense trypanosomiasis patients relapsing after initial treatment with melarsoprol were treated with a sequential combination of intravenous eflornithine (100 mg/kg every 6 h for 4 days) followed by three daily injections of melarsoprol (3.6 mg/kg, up to 180 mg). They were then followed-up for 24 months. RESULTS: Two (4.8%) patients died during treatment. Of the 40 surviving patients, two had a treatment failure, 13 and 19 months after having received the combination therapy. By Kaplan-Meier analysis, the 2-year probability of cure was 93.3% (95% confidence interval: 84.3-100%). CONCLUSION: This sequential combination has an efficacy and a toxicity similar to a 7-day course of eflornithine monotherapy, but is easier to administer. Whether such therapeutic success corresponds tosynergism between eflornithine and melarsoprol, or merely means that 4 days of eflornithine monotherapy suffices for such patients, will need to be determined in a comparative trial.
OBJECTIVE: To evaluate the efficacy and toxicity of a combination of eflornithine and melarsoprol among relapsing cases of Gambian trypanosomiasis. METHODS: Forty-two late-stage Trypanosoma brucei gambiense trypanosomiasispatients relapsing after initial treatment with melarsoprol were treated with a sequential combination of intravenous eflornithine (100 mg/kg every 6 h for 4 days) followed by three daily injections of melarsoprol (3.6 mg/kg, up to 180 mg). They were then followed-up for 24 months. RESULTS: Two (4.8%) patients died during treatment. Of the 40 surviving patients, two had a treatment failure, 13 and 19 months after having received the combination therapy. By Kaplan-Meier analysis, the 2-year probability of cure was 93.3% (95% confidence interval: 84.3-100%). CONCLUSION: This sequential combination has an efficacy and a toxicity similar to a 7-day course of eflornithine monotherapy, but is easier to administer. Whether such therapeutic success corresponds tosynergism between eflornithine and melarsoprol, or merely means that 4 days of eflornithine monotherapy suffices for such patients, will need to be determined in a comparative trial.
Authors: Kofi D Kwofie; Nguyen Huu Tung; Mitsuko Suzuki-Ohashi; Michael Amoa-Bosompem; Richard Adegle; Maxwell M Sakyiamah; Frederick Ayertey; Kofi Baffour-Awuah Owusu; Isaac Tuffour; Philip Atchoglo; Kwadwo K Frempong; William K Anyan; Takuhiro Uto; Osamu Morinaga; Taizo Yamashita; Frederic Aboagye; Alfred A Appiah; Regina Appiah-Opong; Alexander K Nyarko; Yasuchika Yamaguchi; Dominic Edoh; Kwadwo A Koram; Shoji Yamaoka; Daniel A Boakye; Nobuo Ohta; Yukihiro Shoyama; Irene Ayi Journal: Antimicrob Agents Chemother Date: 2016-05-23 Impact factor: 5.191