TY - JOUR
T1 - New WHO guidelines for treatment of gambiense human African trypanosomiasis including fexinidazole:
T2 - substantial changes for clinical practice
AU - Lindner, Andreas Karl
AU - Veerle, Lejon,
AU - François, Chappuis,
AU - Seixas, J
AU - Leon, Kazumba,
AU - Michael P. , Barrett,
AU - Erick, Mwamba,
AU - Olema, Erphas,
AU - Akl, Elie A,
AU - Gemma , Villanueva,
AU - Bergman, Hanna
AU - Pere , Simarro,
AU - Augustin Kadima, Ebeja,
AU - Gerardo , Priotto,
AU - Jose Ramon , Franco,
PY - 2020/2
Y1 - 2020/2
N2 - Human African trypanosomiasis caused by Trypanosoma brucei gambiense is a parasitic infection that usually progresses to coma and death unless treated. WHO has updated its guidelines for the treatment of this infection on the basis of independent literature reviews and using the Grading of Recommendations Assessment, Development and Evaluation methodology. The first-line treatment options, pentamidine and nifurtimox-eflornithine combination therapy, have been expanded to include fexinidazole, an oral monotherapy given a positive opinion from the European Medicines Agency. Fexinidazole is recommended for individuals who are aged 6 years and older with a bodyweight of 20 kg or more, who have first-stage or second-stage gambiense human African trypanosomiasis and a cerebrospinal fluid leucocyte count less than 100 per μL. Nifurtimox-eflornithine combination therapy remains recommended for patients with 100 leucocytes per μL or more. Without clinical suspicion of severe second-stage disease, lumbar puncture can be avoided and fexinidazole can be given. Fexinidazole should only be administered under supervision of trained health staff. Because these recommendations are expected to change clinical practice considerably, health professionals should consult the detailed WHO guidelines. These guidelines will be updated as evidence accrues.
AB - Human African trypanosomiasis caused by Trypanosoma brucei gambiense is a parasitic infection that usually progresses to coma and death unless treated. WHO has updated its guidelines for the treatment of this infection on the basis of independent literature reviews and using the Grading of Recommendations Assessment, Development and Evaluation methodology. The first-line treatment options, pentamidine and nifurtimox-eflornithine combination therapy, have been expanded to include fexinidazole, an oral monotherapy given a positive opinion from the European Medicines Agency. Fexinidazole is recommended for individuals who are aged 6 years and older with a bodyweight of 20 kg or more, who have first-stage or second-stage gambiense human African trypanosomiasis and a cerebrospinal fluid leucocyte count less than 100 per μL. Nifurtimox-eflornithine combination therapy remains recommended for patients with 100 leucocytes per μL or more. Without clinical suspicion of severe second-stage disease, lumbar puncture can be avoided and fexinidazole can be given. Fexinidazole should only be administered under supervision of trained health staff. Because these recommendations are expected to change clinical practice considerably, health professionals should consult the detailed WHO guidelines. These guidelines will be updated as evidence accrues.
UR - https://www.sciencedirect.com/science/article/pii/S1473309919306127?via%3Dihub
U2 - 10.1016/S1473-3099(19)30612-7
DO - 10.1016/S1473-3099(19)30612-7
M3 - Review article
C2 - 31879061
SN - 1473-3099
VL - 20
SP - e38-e46
JO - Lancet Infectious Diseases
JF - Lancet Infectious Diseases
IS - 2
ER -