Beneficial effects of benznidazole in Chagas disease: NIH SaMi-Trop cohort study.

• Published in: PLOS Neglected Tropical Diseases
• Main Authors: Clareci Silva Cardoso, Antonio Luiz P Ribeiro, Claudia Di Lorenzo Oliveira, Lea Campos Oliveira, Ariela Mota Ferreira, Ana Luiza Bierrenbach, José Luiz Padilha Silva, Enrico Antonio Colosimo, João Eduardo Ferreira, Tzong-Hae Lee, Michael P Busch, Arthur Lawrence Reingold, Ester Cerdeira Sabino
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2018
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic; sami
• Online Access: https://doi.org/10.1371/journal.pntd.0006814; https://doaj.org/article/a70539306698432a8f1122a164cfa6db

BACKGROUND:The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD. METHODS:The study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity. RESULTS:Mortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45]. CONCLUSION:Patients previously treated with benznidazole had significantly reduced parasitemia, a lower prevalence of markers of severe cardiomyopathy, and lower mortality after two years of follow-up. If used in the early phases, benznidazole treatment may improve clinical and parasitological outcomes in patients with chronic ChD. TRIAL REGISTRATION:ClinicalTrials.gov, Trial registration: NCT02646943.