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Melarsoprol: discovered in 1949, it is at present the only drug available on the market to treat the advanced stage of sleeping sickness, no matter which parasite is the cause. It is the last arsenical derivative in existence. The undesired effects are drastic; they include reactive encephalopathy (an hyperacute neurological complication of an allergic nature) - often fatal - in 3% to 10% of cases; those who survive the encephalopathy suffer serious neurological sequelae. Furthermore, there is considerable resistance to the drug, rising to 30% in parts of central Africa.
Eflornithine: this molecule, which was registered in 1990, is the alternative to melarsoprol treatment. It is effective only against T.b. gambiense. The regimen is strict and hard to apply. Production ceased in 1999. Last year, the company Aventis gave the licence to WHO, which has undertaken several initiatives to seek a new source of production.
In short, most drugs are old, difficult to administer in poor conditions and by no means always successful. Early diagnosis of the disease, which would guarantee low-risk treatment on an outpatient basis, can rarely be achieved. It is absolutely necessary that a new producer continues the production and the marketing of Eflornithine, the only currently available medicine which can treat the neurological phase of T.b. gambiense.
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