title: Effectiveness of a 10-day melarsoprol schedule for the treatment of late-stage human African trypanosomiasis: confirmation from a multinational study (IMPAMEL II).
abstract: BACKGROUND
  Treatment of late-stage human African trypanosomiasis (HAT) with melarsoprol can be improved by shortening the regimen. A previous trial demonstrated the safety and efficacy of a 10-day treatment schedule. We demonstrate the effectiveness of this schedule in a noncontrolled, multinational drug-utilization study.
  
  
  METHODS
  A total of 2020 patients with late-stage HAT were treated with the 10-day melarsoprol schedule in 16 centers in 7 African countries. We assessed outcome on the basis of major adverse events and the cure rate after treatment and during 2 years of follow-up.
  
  
  RESULTS
  The cure rate 24 h after treatment was 93.9%; 2 years later, it was 86.2%. However, 49.3% of patients were lost to follow-up. The overall fatality rate was 5.9%. Of treated patients, 8.7% had an encephalopathic syndrome that was fatal 45.5% of the time. The rate of severe bullous and maculopapular eruptions was 0.8% and 6.8%, respectively.
  
  
  CONCLUSIONS
  The 10-day treatment schedule was well implemented in the field and was effective. It reduces treatment duration, drug amount, and hospitalization costs per patient, and it increases treatment-center capacity. The shorter protocol has been recommended by the International Scientific Council for Trypanosomiasis Research and Control for the treatment of late-stage HAT caused by Trypanosoma brucei gambiense.
authors.affiliation: Swiss Tropical Institute, Basel.
authors.forename: Caecilia
authors.initials: C
authors.lastname: Schmid
authors.forename: Michaleen
authors.initials: M
authors.lastname: Richer
authors.forename: Constantin Miaka Mia
authors.initials: CM
authors.lastname: Bilenge
authors.forename: Théophile
authors.initials: T
authors.lastname: Josenando
authors.forename: Francois
authors.initials: F
authors.lastname: Chappuis
authors.forename: Claude R
authors.initials: CR
authors.lastname: Manthelot
authors.forename: Auguste
authors.initials: A
authors.lastname: Nangouma
authors.forename: Félix
authors.initials: F
authors.lastname: Doua
authors.forename: Pedro N
authors.initials: PN
authors.lastname: Asumu
authors.forename: Pere P
authors.initials: PP
authors.lastname: Simarro
authors.forename: Christian
authors.initials: C
authors.lastname: Burri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008549:Melarsoprol / Q000627:therapeutic use*; D008875:Middle Aged; D013997:Time Factors; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014353:Trypanosomiasis, African / Q000188:drug therapy*
chemical_list: D014344:Trypanocidal Agents; D008549:Melarsoprol