Treatments for sleeping sickness were so bad in 2004 that they were even deadly.
The arsenic-based drug was toxic at the time. Up to 5% of patients could be killed by it. Two of my patients passed away. That was a terrible experience for them.
Sleeping sickness is a disease caused by a parasites that can cause people to sleep all day and night. It is endemic to 36 countries in Africa, but most of the time it occurs in the Democratic Republic of the Congo.
A new oral drug has been shown to cure sleeping sickness with just a single dose. The results of clinical trials for a new drug were published in November.
The World Health Organization wants to eliminate sleeping sickness by the year 2030.
There are two different types of sleeping sickness. Trypanosoma brucei gambiense is the most common form of the disease. Humans are the primary source of the parasites. There were 300,000 cases per year in the late '90s, but the number has dropped to less than 1000 cases per year.
When people are first bitten, their symptoms can look a lot like Malaria, but eventually they can develop behavioral issues, paralysis and sleep problems.
Treatments have consisted of multiple injections for weeks on end. Patients had to get a puncture in their back to detect the parasites and assess the effectiveness of treatment.
People were afraid to be diagnosed with sleeping sickness because of the puncture of the back. In 30 to 50% of patients, there was a chance of a relapse, and in the other 50%, there was a chance of death.
Even though treatments became less toxic and more effective, the last drug for sleeping sickness approved for use in this year still requires 10 days of treatment.
The paper describes a new drug that will cause the parasites to die after a single oral dose. The drug was able to cure almost 200 patients after 18 months.
Dr. Tarral, one of the scientists who helped develop the new drug, is unsure if the three patients who were not cured are actually a reinfection or a relapse.
The authors of the paper describing the results of the clinical trial were Mutombo and Tarral.
The single oral dose of a highly effective drug will make treatment much more accessible to vulnerable populations. The drug can be given in the hospitals but also in the villages, according to Dr. Jacques Pépin, a retired professor at the University of Sherbrooke, Québec.
Pépin's enthusiasm that acoziborole is a major development in treating sleeping sickness is not the only critique he has. He says that the trial was not in line with current standards because it was not a randomized control trial where half of the patients received the new treatment and half of the patients received the previous recommended treatment.
There are so few cases of sleeping sickness that it was not necessary to do better, even though the number of patients treated in the trial was relatively low. Pépin is still positive about the drug's potential.
The drug will not be available for another year or two as it goes through the drug registration and approval process. The WHO needs a few years to eliminate sleeping sickness.
Pépin thinks the elimination deadline is going to be difficult. The last few miles are hard to eradicate a disease from. It's hard to get to the magic number.
Pépin thinks it will be hard to eliminate sleeping sickness. Logistical of testing and treatment is more difficult in countries that are politically unstable. The second reason is that once the disease becomes uncommon, it will become harder to convince people to participate. Sleeping sickness can provide another source for the parasites. If a tsete fly bites an animal, it could transmit the disease to people.
The drug's production could be a problem. Usually the drug is free of charge for the patient, and the production of the drug is not very expensive. The patient can be treated with less than one gram of substance. Finding an organization or factory that accepts to produce a low number of products is difficult.
There is hope for the new drug despite the problems. He thinks elimination is doable because of the tool we have.
Tarral is more conservative in his projections. He thinks we could simplify the treatment and decrease the number of patients.
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