Status: NECT (Nifurtimox-Eflornithine Combination Therapy) has been available to patients since the end of 2009 and is the first new treatment for sleeping sickness in 25 years. NECT consists of a simplified co-administration of oral nifurtimox and intravenous eflornithine. Developed by DNDi, Epicentre, Médecins Sans Frontières (MSF), the Swiss Tropical and Public Health Institute (Swiss TPH), and the National Trypanosomiasis Control Programmes of the Republic of Congo and the Democratic Republic of the Congo (DRC), NECT reduces the total number of infusions of eflornithine from 56 to 14, shortens hospitalization from 14 days to 10 and cuts the cost of treatment by half. Because NECT requires only two infusions a day that can be administered during daytime, it significantly reduces the burden on health staff, and makes the treatment far more adaptable for the resource-poor settings where HAT treatments take place.
Thanks to the inclusion in the WHO Essential Medicines List (May 2009), endemic countries have now begun ordering the new combination treatment through the WHO. As of December 2010, 10 countries – which together treat more than 97% of all HAT T.b. gambiense patients – have requested NECT as a treatment for HAT in their territories: Angola, Cameroon, Central African Republic, Chad, the Democratic Republic of Congo, Equatorial Guinea, Gabon, Ivory Coast, South Sudan, and Uganda. Six of them have received the supplies from the WHO – nearly 6,000 treatments – and have begun to treat patients (2,176 patients treated with NECT by the end of 2010). Since the launch of NECT in the second half of 2009, melarsoprol and eflornithine in monotherapy are increasingly being replaced by NECT (see table below). The HAT Platform continues advocating for the use of NECT, which offers a safer and better field-adapted treatment for stage 2 sleeping sickness.

DNDi and its partners are conducting a Phase IIIb “NECTField” study, to further document the safety and ease of use of the combination in real-life field conditions and in special populations like children, pregnant women, and lactating women. The enrolment started in April 2009 and by December 2010, 630 patients had been enrolled for the study (including 100 children and more than 40 pregnant women). They will be followed up for 2 years.