Combination of eflornithine and melarsoprol for melarsoprol-resistant Gambian trypanosomiasis.
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%).


CONCLUSIONS
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.
Mpia
Bokelo
B
Hôpital de Nioki, Nioki, Democratic Republic of Congo. jpepin01@courrier.usherb.ca
Pépin
Jacques
J
D000293:Adolescent; D000328:Adult; D003223:Congo; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D000518:Eflornithine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008549:Melarsoprol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014352:Trypanosomiasis / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology
D014344:Trypanocidal Agents; D008549:Melarsoprol; D000518:Eflornithine