Effectiveness of a 10-Day Melarsoprol Schedule for the Treatment of Late-Stage Human African Trypanosomiasis: Confirmation from a Multinational

(See the editorial commentary by Moore, on pages 1793–5.) 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 af-ter 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