Therapy, diagnosis and prognosis of chronic Chagas disease: insight gained in Argentina

Sosa-Estáni, Sergio; Viotti, Rodolfo; Segura, Elsa L.

doi:10.1590/s0074-02762009000900023

Cited by 72 publications

(75 citation statements)

References 86 publications

(90 reference statements)

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“…One previous report and several subsequent nonrandomized studies have shown improved clinical and serological evolution for treatment with benznidazole compared with the same parameters in untreated chronic patients (26,(33)(34)(35)(36)(37). Numerous subsequent studies and evidence supporting etiologic treatment of chronic CD are summarized elsewhere (27), while Table 1 summarizes the results of etiologic treatment in chronic patients from four nonrandomized studies (38). These latter studies demonstrate better clinical evolution in antiparasitetreated patients.…”

Section: What Is Considered Efficacy: a Lower Parasite Burden Or Paramentioning

confidence: 95%

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

Viotti¹,

Noya

Araújo-Jorge

et al. 2014

Antimicrob Agents Chemother

192

144

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Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. The present opinion, prepared by members of the NHEPACHA network (Nuevas Herramientas para el Diagnóstico y la Evaluación del Paciente con Enfermedad de Chagas/New Tools for the Diagnosis and Evaluation of Chagas Disease Patients), reviews the paradigm shift based on clinical and immunological evidence and argues in favor of antiparasitic treatment for all chronic patients. We review the tools needed to monitor therapeutic efficacy and the potential criteria for evaluation of treatment efficacy beyond parasitological cure. Etiological treatment should now be mandatory for all adult chronic Chagas disease patients.

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Section: What Is Considered Efficacy: a Lower Parasite Burden Or Paramentioning

confidence: 95%

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

Viotti¹,

Noya

Araújo-Jorge

et al. 2014

Antimicrob Agents Chemother

192

144

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“…The major limitation on the use of both BZ and NF is low anti-parasitic activity in the chronic phase, with only 5-20% of patients considered cured, as assessed by 20 years or more follow-up (Cançado 2002, Dias 2006. On the other hand, BZ treatment in this phase yields a better prognosis for the clinical evolution of chagasic cardiomyopathies (Viotti et al 2006, Sosa-Estani et al 2009). …”

Section: ± 1 µM Comparison Of Bz Susceptibility Of the Pre-treatmentmentioning

confidence: 99%

Trypanosoma cruzi benznidazole susceptibility in vitro does not predict the therapeutic outcome of human Chagas disease

Moreno

D’Ávila²,

Silva

et al. 2010

Mem. Inst. Oswaldo Cruz

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“…Several observational studies with benznidazole administered at 5 mg/kg/day for 30 days in adult patients with Chagas disease have shown a reduction in the progression of heart disease and a conversion to negative findings by conventional serological tests up to 30% of treated patients after a long-term follow-up (4)(5)(6)(7)(8)(9). On the other hand, two randomized studies with benznidazole administered for 60 days in T. cruzi-infected children up to 14 years of age demonstrated an antiparasitic efficacy (10,11) and led to extrapolation of this duration of treatment to adult patients, as stated in most international guidelines.…”

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confidence: 99%

New Scheme of Intermittent Benznidazole Administration in Patients Chronically Infected with Trypanosoma cruzi: a Pilot Short-Term Follow-Up Study with Adult Patients

Alvarez¹,

Hernández

Bertocchi³

et al. 2016

Antimicrob Agents Chemother

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There is a clinical need to test new schemes of benznidazole administration that are expected to be at least as effective as the current therapeutic scheme but safer. This study assessed a new scheme of benznidazole administration in chronic Chagas disease patients. A pilot study with intermittent doses of benznidazole at 5 mg/kg/day in two daily doses every 5 days for a total of 60 days was designed. The main criterion of response was the comparison of quantitative PCR (qPCR) findings prior to and 1 week after the end of treatment. The safety profile was assessed by the rate of suspensions and severity of adverse effects. Twenty patients were analyzed for safety, while qPCR was tested for 17 of them. The average age was 43 ؎ 7.9 years; 55% were female. Sixty-five percent of treated subjects showed detectable qPCR results prior to treatment of 1.45 (0.63 to 2.81) and 2.1 (1.18 to 2.78) parasitic equivalents per milliliter of blood (par.eq/ml) for kinetoplastic DNA (kDNA) qPCR and nuclear repetitive sequence satellite DNA (SatDNA) qPCR, respectively. One patient showed detectable PCR at the end of treatment (1/17), corresponding to 6% treatment failure, compared with 11/17 (65%) patients pretreatment (P ‫؍‬ 0.01). Adverse effects were present in 10/20 (50%) patients, but in only one case was treatment suspended. Eight patients showed mild adverse effects, whereas moderate reactions with increased liver enzymes were observed in two patients. The main accomplishment of this pilot study is the promising low rate of treatment suspension. Intermittent administration of benznidazole emerges a new potential therapeutic scheme, the efficacy of which should be confirmed by long-term assessment posttreatment.

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Therapy, diagnosis and prognosis of chronic Chagas disease: insight gained in Argentina

Cited by 72 publications

References 86 publications

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

Trypanosoma cruzi benznidazole susceptibility in vitro does not predict the therapeutic outcome of human Chagas disease

New Scheme of Intermittent Benznidazole Administration in Patients Chronically Infected with Trypanosoma cruzi: a Pilot Short-Term Follow-Up Study with Adult Patients

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