Document Detail

Efficacy and toxicity of eflornithine for treatment of Trypanosoma brucei gambiense sleeping sickness.
MedLine Citation:
PMID:  1355219     Owner:  NLM     Status:  MEDLINE    
The usual first-line treatment for Trypanosoma brucei gambiense sleeping sickness is melarsoprol, but when that fails the outlook has hitherto been grim. The polyamine synthesis inhibitor eflornithine (difluoromethylornithine, DFMO) has emerged as an alternative therapy. 207 patients with late-stage T b gambiense sleeping sickness were treated in rural Zaire with three different regimens of DFMO in an open-trial design. During treatment, trypanosomes disappeared from the CSF of all 87 patients in whom parasites had been seen before DFMO administration, and there was a sharp fall in CSF white cell count from a mean of 186/microliters to 21/microliters. 152 patients have been followed for at least a year after DFMO treatment, and only 13 (9%) have relapsed. Treatment failures were more common in children less than 12 years, among patients treated with oral DFMO only, and among patients who received DFMO as the initial treatment of their recently diagnosed trypanosomiasis. Toxicity was acceptable. Only 4 patients died during or shortly after treatment. Bone marrow suppression resulting in anaemia (43%) or leucopenia (53%) was common but bore little consequence. This open trial shows that DFMO is as active as and possibly less toxic than melarsoprol. For economic and logistic reasons DFMO may not be the first-choice therapy in rural Africa but for the vast majority of patients who relapse after melarsoprol DFMO will be curative.
F Milord; J Pépin; L Loko; L Ethier; B Mpia
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Lancet     Volume:  340     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  1992 Sep 
Date Detail:
Created Date:  1992-10-01     Completed Date:  1992-10-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  652-5     Citation Subset:  AIM; IM    
Department of Medicine, University of Sherbrooke, Canada.
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MeSH Terms
Administration, Oral
Cerebrospinal Fluid / cytology,  parasitology
Democratic Republic of the Congo / epidemiology
Diarrhea / chemically induced,  epidemiology
Eflornithine / administration & dosage,  adverse effects,  therapeutic use*
Hematologic Diseases / chemically induced,  epidemiology
Hospitals, Rural
Infusions, Intravenous
Leukocyte Count / drug effects
Seizures / chemically induced,  epidemiology
Trypanosoma brucei gambiense*
Trypanosomiasis, African / diagnosis,  drug therapy*,  epidemiology
Reg. No./Substance:

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