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New WHO guidelines for treating rhodesiense human African trypanosomiasis: expanded indications for fexinidazole and pentamidine. | LitMetric

AI Article Synopsis

  • - Human African trypanosomiasis is a severe neglected tropical disease that can be fatal without treatment, and the WHO has updated its treatment guidelines after a thorough review.
  • - Fexinidazole is now the preferred first-line treatment for patients aged 6 years and over who weigh at least 20 kg, eliminating the need for invasive lumbar punctures for staging the disease.
  • - While fexinidazole improves treatment options and reduces the risk of severe side effects from previous medicines, it remains unavailable for children who don't meet the age or weight criteria, making interim use of pentamidine necessary in some cases.

Article Abstract

Human African trypanosomiasis is a neglected tropical disease that is usually fatal without treatment. WHO has revised its rhodesiense human African trypanosomiasis treatment guidelines on the basis of an independent systematic literature review and following the GRADE methodology. This Review reports on the decision-making process and summarises the new recommendations and their potential implications for health-care professionals and policy makers. Due to data scarcity, all recommendations are conditional and based on very low certainty of evidence. Fexinidazole replaces suramin and melarsoprol as the first-line therapy in individuals aged 6 years and older with a bodyweight of 20 kg or more. As fexinidazole is effective in both stages of rhodesiense human African trypanosomiasis, a lumbar puncture for staging is no longer required. In settings in which first-choice drugs are not readily available, immediate interim treatment with pentamidine is suggested. The introduction of oral fexinidazole represents an advancement in the management of rhodesiense human African trypanosomiasis considering the life-threatening adverse reactions individuals can have to melarsoprol. However, children below the age or weight limits remain ineligible for treatment with fexinidazole.

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Source
http://dx.doi.org/10.1016/S1473-3099(24)00581-4DOI Listing

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