Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis.
Chagas disease is a neglected disease that remains a public health threat, particularly in Latin America. The most important treatment options are nitroimidazole derivatives, such as nifurtimox and benznidazole (BZN). Some studies suggest that for adults seropositive to T. cruzi but without clinical...
Published in: | PLOS Neglected Tropical Diseases |
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ftdoajarticles:oai:doaj.org/article:dfa63decbe624f75ac4d6f62d5efe425 2023-05-15T15:15:32+02:00 Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. Agustín Ciapponi Fabiana Barreira Lucas Perelli Ariel Bardach Joaquim Gascón Israel Molina Carlos Morillo Nilda Prado Adelina Riarte Faustino Torrico Isabela Ribeiro Juan Carlos Villar Sergio Sosa-Estani 2020-08-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0008529 https://doaj.org/article/dfa63decbe624f75ac4d6f62d5efe425 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0008529 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008529 https://doaj.org/article/dfa63decbe624f75ac4d6f62d5efe425 PLoS Neglected Tropical Diseases, Vol 14, Iss 8, p e0008529 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0008529 2022-12-31T07:51:08Z Chagas disease is a neglected disease that remains a public health threat, particularly in Latin America. The most important treatment options are nitroimidazole derivatives, such as nifurtimox and benznidazole (BZN). Some studies suggest that for adults seropositive to T. cruzi but without clinically evident chronic Chagas cardiomyopathy (CCC), a simple fixed-dose scheme of BZN could be equivalent to a weight-adjusted dose. We compared the efficacy and safety of a fixed dose of BZN with an adjusted dose for T. cruzi seropositive adults without CCC. We used the Cochrane methods, and reported according to the PRISMA statement. We included randomized controlled trials (RCTs) allocating participants to fixed and/or adjusted doses of BZN for T. cruzi seropositive adults without CCC. We searched (December 2019) Cochrane, MEDLINE, EMBASE, LILACS, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP), and contacted Chagas experts. Selection, data extraction, and risk of bias assessment, using the Cochrane tool, were performed independently by pairs of reviewers. Discrepancies were solved by consensus within the team. Primary outcomes were parasite-related outcomes and efficacy or patient-related safety outcomes. We conducted a meta-analysis using RevMan 5.3 software and used GRADE summary of finding tables to present the certainty of evidence by outcome. We identified 655 records through our search strategy and 10 studies (four of them ongoing) met our inclusion criteria. We did not find any study directly comparing fixed vs adjusted doses of BZN, however, some outcomes allowed subgroup comparisons between fixed and adjusted doses of BZN against placebo. Moderate-certainty evidence suggests no important subgroup differences for positive PCR at one year and for three safety outcomes (drug discontinuation, peripheral neuropathy, and mild rash). The same effect was observed for any serious adverse events (low-certainty evidence). All subgroups showed similar effects (I2 0% for all these subgroup ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Prisma ENVELOPE(-58.767,-58.767,-69.200,-69.200) PLOS Neglected Tropical Diseases 14 8 e0008529 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
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English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Agustín Ciapponi Fabiana Barreira Lucas Perelli Ariel Bardach Joaquim Gascón Israel Molina Carlos Morillo Nilda Prado Adelina Riarte Faustino Torrico Isabela Ribeiro Juan Carlos Villar Sergio Sosa-Estani Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Chagas disease is a neglected disease that remains a public health threat, particularly in Latin America. The most important treatment options are nitroimidazole derivatives, such as nifurtimox and benznidazole (BZN). Some studies suggest that for adults seropositive to T. cruzi but without clinically evident chronic Chagas cardiomyopathy (CCC), a simple fixed-dose scheme of BZN could be equivalent to a weight-adjusted dose. We compared the efficacy and safety of a fixed dose of BZN with an adjusted dose for T. cruzi seropositive adults without CCC. We used the Cochrane methods, and reported according to the PRISMA statement. We included randomized controlled trials (RCTs) allocating participants to fixed and/or adjusted doses of BZN for T. cruzi seropositive adults without CCC. We searched (December 2019) Cochrane, MEDLINE, EMBASE, LILACS, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP), and contacted Chagas experts. Selection, data extraction, and risk of bias assessment, using the Cochrane tool, were performed independently by pairs of reviewers. Discrepancies were solved by consensus within the team. Primary outcomes were parasite-related outcomes and efficacy or patient-related safety outcomes. We conducted a meta-analysis using RevMan 5.3 software and used GRADE summary of finding tables to present the certainty of evidence by outcome. We identified 655 records through our search strategy and 10 studies (four of them ongoing) met our inclusion criteria. We did not find any study directly comparing fixed vs adjusted doses of BZN, however, some outcomes allowed subgroup comparisons between fixed and adjusted doses of BZN against placebo. Moderate-certainty evidence suggests no important subgroup differences for positive PCR at one year and for three safety outcomes (drug discontinuation, peripheral neuropathy, and mild rash). The same effect was observed for any serious adverse events (low-certainty evidence). All subgroups showed similar effects (I2 0% for all these subgroup ... |
format |
Article in Journal/Newspaper |
author |
Agustín Ciapponi Fabiana Barreira Lucas Perelli Ariel Bardach Joaquim Gascón Israel Molina Carlos Morillo Nilda Prado Adelina Riarte Faustino Torrico Isabela Ribeiro Juan Carlos Villar Sergio Sosa-Estani |
author_facet |
Agustín Ciapponi Fabiana Barreira Lucas Perelli Ariel Bardach Joaquim Gascón Israel Molina Carlos Morillo Nilda Prado Adelina Riarte Faustino Torrico Isabela Ribeiro Juan Carlos Villar Sergio Sosa-Estani |
author_sort |
Agustín Ciapponi |
title |
Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. |
title_short |
Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. |
title_full |
Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. |
title_fullStr |
Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. |
title_full_unstemmed |
Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis. |
title_sort |
fixed vs adjusted-dose benznidazole for adults with chronic chagas disease without cardiomyopathy: a systematic review and meta-analysis. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
url |
https://doi.org/10.1371/journal.pntd.0008529 https://doaj.org/article/dfa63decbe624f75ac4d6f62d5efe425 |
long_lat |
ENVELOPE(-58.767,-58.767,-69.200,-69.200) |
geographic |
Arctic Prisma |
geographic_facet |
Arctic Prisma |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 14, Iss 8, p e0008529 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0008529 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008529 https://doaj.org/article/dfa63decbe624f75ac4d6f62d5efe425 |
op_doi |
https://doi.org/10.1371/journal.pntd.0008529 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
14 |
container_issue |
8 |
container_start_page |
e0008529 |
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1766345900847792128 |