Chemotherapy for second-stage Human African trypanosomiasis.

Area of Science:

• Tropical medicine
• Infectious diseases
• Pharmacology

Background:

• Human African trypanosomiasis (sleeping sickness) is a severe, fatal disease prevalent in impoverished African regions.
• Limited treatment options exist for second-stage sleeping sickness, often associated with significant adverse events and variable efficacy.

Purpose of the Study:

• To systematically evaluate the effectiveness and safety of available drugs for treating second-stage human African trypanosomiasis (HAT).

Main Methods:

• Comprehensive literature search of multiple databases (Cochrane, MEDLINE, EMBASE, etc.) and contact with researchers.
• Inclusion of randomized and quasi-randomized controlled trials.
• Data extraction and quality assessment by multiple authors, with dichotomous outcomes presented as risk ratios (RR) and 95% confidence intervals (CI).

Main Results:

• Nine trials involving 2577 participants with Trypanosoma brucei gambiense HAT were analyzed.
• Melarsoprol showed similar efficacy for 10-day and 26-day regimens but had more adverse events than pentamidine or nifurtimox monotherapy.
• Nifurtimox-eflornithine combination therapy (NECT) demonstrated low relapse rates and good tolerability, with practical advantages over eflornithine monotherapy.

Conclusions:

• Eflornithine and NECT are poised to supersede melarsoprol for second-stage Gambiense HAT, contingent on local availability and vigilant parasite resistance monitoring.
• Further research is crucial for mitigating adverse drug effects, exploring alternative regimens, and developing novel compounds effective for all stages of HAT.