Therapeutic drug monitoring of benznidazole and nifurtimox: a systematic review and quality assessment of published clinical practice guidelines

Abstract

The pharmacological management of adults with chronic-phase Chagas disease is challenging despite it being the recent focus of extensive research. One of the challenges in the current clinical practice guidelines (CPGs) landscape is the existence of nonevidence-based recommendations for the use of laboratory tests in treatment monitoring. This study aimed to systematically assess the quality and consistency of recommendations of CPGs on the pharmacological management of adults with chronicphase Chagas disease. Systematic literature searches were conducted in MEDLINE, EMBASE, SciELO and Google to identify all published CPGs relevant to the pharmacological management of Chagas disease, between January 2010 and March 2016. Three independent reviewers assessed the quality of each CPG using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. A total of fi ve CPGs were included and the overall quality of the guidelines for therapeutic drug monitoring of Chagas disease was moderate-to-low. There was considerable variation in the quality of the CPGs across the AGREE II domains. The domains of scope/purpose, stakeholder involvement, and clarity of presentation were rated well, and the domains of applicability and editorial independence received poor ratings. This review showed that the methodological quality of CPGs for Chagas disease was generally inappropriate, and there was no explicit link between the best available evidence and current recommendations.

The continuous challenge of Chagas disease treatment: bridging evidence-based guidelines, access to healthcare, and human rights

“…The study titled Therapeutic drug monitoring of benznidazole and nifurtimox: A systematic review and quality assessment of published clinical practice guidelines by Oliveira MJ, et al 10 . The literature search in this study was restricted to articles published from January 2010 to March 2016 10 .…”

“…The literature search in this study was restricted to articles published from January 2010 to March 2016 10 . In Brazil, a new Consensus on Chagas disease was published in December 2016; bringing in a more structured and evidence-based guideline 1,4 .…”

“…Other countries, such as Bolivia, Colombia, and Argentina are in the process of developing new adjusted national guidelines for Chagas disease 5,8 . In addition to the initial non-availability of evidence-based guidelines, there was also a lack of minimum standardization between and within the different countries, which created even greater obstacles for an integrated global response 9,10 .…”

“…Signifi cant differences were found on the pharmacological management, duration of treatment, standards of clinical controls, and the role of laboratory tests 10 . These differences can impact the access to health care contributing to worse health outcomes 9,10 .…”

“…Signifi cant differences were found on the pharmacological management, duration of treatment, standards of clinical controls, and the role of laboratory tests 10 . These differences can impact the access to health care contributing to worse health outcomes 9,10 . Some national strategies have been developed in endemic countries as a solution to unmet demands in improving access to Chagas disease diagnosis and treatment 1,9 .…”