Benznidazole Provides Long-Term Efficacy in Chagas Disease

TOPLINE:

A long-term follow-up study among patients with chronic Chagas disease showed that the time to positive molecular detection of the disease was significantly shorter with posaconazole than with benznidazole. Almost two thirds of patients treated initially with posaconazole were re-treated with benznidazole.

METHODOLOGY:

• Researchers conducted a follow-up analysis of a prospective observational study to assess the long-term clinical and parasitological outcomes of treatment with posaconazole and benznidazole in patients with chronic Chagas disease.
• Overall, 72 patients (median age, 37 years; 64% women) from the CHAGASAZOL cohort were followed up (median follow-up, 71 months) and were randomly assigned to receive either posaconazole (8srcsrc mg/d or 2srcsrc mg/d) or benznidazole (3srcsrc mg/d).
• Patients underwent clinical examination, ECG, and quantitative polymerase chain reaction (qPCR) detection for Trypanosoma cruzi at 6-12 months post-treatment. Those with parasitological failure (positive qPCR results) in the posaconazole group were offered re-treatment with benznidazole.
• The primary endpoint was sustained negative detection for T cruzi on qPCR assays; secondary endpoints were the timely distribution of parasitological failures, side effects of benznidazole in initially treated vs re-treated patients, and long-term clinical outcomes during the follow-up period.

TAKEAWAY:

• Overall, 43 of 45 posaconazole recipients showed positive qPCR results during the follow-up period, with 35 subsequently re-treated with benznidazole. Only three of 51 participants treated with benznidazole (initially or as re-treatment) showed positive qPCR results, all receiving the complete regimen of 6src days.
• The time to positive qPCR was significantly shorter with posaconazole than with benznidazole (17 months; 95% CI, 9-24 vs 118 months; 95% CI, 111-127; P <.srcsrc1).
• Cardiac progression occurred in four patients over 3-1src years, with an incident rate of src.94 events per 1srcsrc person-years.
• Adverse events were reported in 8src% of participants re-treated with benznidazole, primarily involving cutaneous reactions (6src%) and gastrointestinal disturbances (31%), leading to treatment discontinuation in 26% of patients.

IN PRACTICE:

“Lifelong follow-up should be offered to individuals living with CD [Chagas disease], as both parasitological failure and clinical progression can occur many years after diagnosis and treatment,” the authors wrote.

SOURCE: 

This study was led by Joan Roig-Sanchis, International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain. It was published online on March 27, 2src25, in Clinical Microbiology and Infection.

LIMITATIONS:

The absence of regular echocardiographic evaluations during the follow-up period may have led to an underestimation of cardiac changes in both progression and regression. The study faced significant challenges with participant retention, and many individuals were lost to follow-up. Additionally, the asymptomatic nature of the disease often created a false sense of well-being among participants, complicating long-term monitoring.

DISCLOSURES:

No funding was received for this study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.