Better, simpler, shorter treatment for sleeping sickness patients and health staff

The first improved treatment for sleeping sickness

Before 2009, the best treatment for sleeping sickness, eflornithine, was extremely complex to distribute and administer in regions affected by the disease. All-too-often, doctors would have no choice but to use melarsoprol, a highly toxic, arsenic-based drug that killed 1 in 20 patients.

In 2009, results from DNDi clinical trials showed that a simpler and shorter nifurtimox-eflornithine combination therapy (NECT) was safe and effective to treat sleeping sickness. NECT has significant practical benefits in comparison to eflornithine: there are fewer intravenous infusions (14 instead of 56), treatment length is shorter, and it is more cost effective. As a result, NECT treatment is not only better for patients, it also simplifies the logistics and staffing needed at treatment centres, which are often in remote areas.

  • Indication: stage-2 gambiense sleeping sickness (human African trypanosomiasis)
  • Dosage: 14 intravenous eflornithine infusions for 7 days & 3 times a day oral nifurtimox for 10 days  

Impact

  • Recommended as first-line treatment in all 13 endemic countries, all of which receive free supplies from WHO via drug donations by Sanofi and Bayer
  • 100% of stage-2 gambiense sleeping sickness patients treated with NECT in endemic African countries
  • Added to the WHO Essential Medicines List in 2009, and the WHO Essential Medicines List for Children in 2013.
  • Developed in partnership between DNDi, Médecins Sans Frontières, Epicentre, the HAT Platform, Swiss Tropical & Public Health Institute, national control programmes of the Democratic Republic of the Congo and Republic of Congo, with support of the World Health Organization and drugs donated by Sanofi and Bayer

‘It was 2007 when I began to feel tired and weak. I’d sleep during the day but not at night. I was so weak. I received malaria treatment in 2008, but it didn’t work. I tried traditional medicines, but it didn’t work either. Finally, in 2012 a mobile team came to the village, and we found out I had sleeping sickness. I went to the hospital and received NECT. I’m cured and feel fine now.’

Jean de Dieu Liyande Walo, remote village of Yalikombo

Project updates

2019

With the revision of WHO treatment guidelines for HAT in 2019 and the inclusion of fexinidazole, NECT will become the second-line treatment, though it remains the recommended first-line treatment in cases of advanced disease. Endemic countries will continue to receive free supplies from WHO via drug donations by Sanofi and Bayer. 

2016

NECT was included on the WHO Essential Medicines List in 2009 and extended to the Essential Medicines List for Children in 2013. With the recommendation of NECT as first-line treatment in all endemic countries, all of which receive free supplies from WHO via drug donations by Sanofi and Bayer, 100% of stage-2 HAT patients are now treated with NECT.

2015

NECT has been included in the WHO Essential Medicines List since 2009 and on the Essential Medicines List for children since 2013. Since June 2014, NECT has become available in all endemic countries, which receive free supplies from WHO via drug donations by Sanofi and Bayer.

Key scientific articles

Prescription of concomitant medications in patients treated with Nifurtimox Eflornithine Combination Therapy (NECT) for T.b. gambiense second stage sleeping sickness in the Democratic Republic of the Congo. PLOS Neglected Tropical Diseases, January 2020
by Kuemmerle A, Schmid C, Kande V, Mutombo W, Ilunga M, Lumpungu I, Mutanda S, Nganzobo P, Ngolo D, Kisala M, and Valverde Mordt O.

Treatment options for second-stage gambiense human African trypanosomiasis. Expert Review of Anti-infective Therapy, September 2014
by Eperon G, Balasegaram M, Potet J, Mowbray C, Valverde O, and Chappuis F.

Nifurtimox-eflornithine combination therapy for second-stage gambiense human African trypanosomiasis: Médecins Sans Frontières experience in the Democratic Republic of the Congo. Clinical Infectious Diseases, January 2013
by Alirol E, Schrumpf D, Amici Heradi J, Riedel A, de Patoul C, Quere M, and Chappuis F.

In-hospital safety in field conditions of Nifurtimox Eflornithine Combination Therapy (NECT) for T. b. gambiense sleeping sickness. PLOS Neglected Tropical Diseases, November 2012
by Schmid C, Kuemmerle A, Blum J, Ghabri S, Kande V, Mutombo W, Ilunga M, Lumpungu I, Mutanda S, Nganzobo P, Tete D, Mubwa N, Kisala M, Blesson S, and Valverde Mordt O.

NECT is next: Implementing the new drug combination therapy for Trypanosoma brucei gambiense sleeping sickness. PLOS Neglected Tropical Diseases, May 2010
by Yun O, Priotto G, Tong J, Flevaud L, and Chappuis F. 

Nifurtimox-eflornithine combination therapy for second-stage African Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomised, phase III, non-inferiority trial. The Lancet, July 2009
by Priotto G, Kasparian S, Mutombo W, Ngouama D, Ghorashian S, Arnold U, Ghabri S, Baudin E, Buard V, Kazadi-Kyanza S, Ilunga M, Mutangala W, Pohlig G, Schmid C, Karunakara U, Torreele E, and Kande V.

Press releases

Additional information

Launch dossier:

*Project cost includes direct and indirect costs, but it does not include in-kind contributions.