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

Chagas disease remains as one of the most neglected infectious diseases of the world, with millions of persons infected and dozens of thousands of deaths every year. The disease has a very long natural history and few options of etiologic treatment, including antiparasitic [1] drugs benznidazole and...

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Bibliographic Details
Published in:PLOS Neglected Tropical Diseases
Main Authors: Cardoso, Clareci Silva, Ribeiro, Antonio Luiz P., Oliveira, Claudia Di Lorenzo, Oliveira, Lea Campos, Ferreira, Ariela Mota, Bierrenbach, Ana Luiza, Silva, José Luiz Padilha, Colosimo, Enrico Antonio, Ferreira, João Eduardo, Lee, Tzong-Hae, Busch, Michael P., Reingold, Arthur Lawrence, Sabino, Ester Cerdeira
Format: Text
Language:English
Published: Public Library of Science 2018
Subjects:
Research Article
sami
Online Access:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211620/
http://www.ncbi.nlm.nih.gov/pubmed/30383777
https://doi.org/10.1371/journal.pntd.0006814
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Summary:Chagas disease remains as one of the most neglected infectious diseases of the world, with millions of persons infected and dozens of thousands of deaths every year. The disease has a very long natural history and few options of etiologic treatment, including antiparasitic [1] drugs benznidazole and nifurtimox. Benznidazole has been recommended for treatment of the disease based mostly in physiopathological assumptions and relatively small observational studies and, recently, a negative trial was published, showing the absence of benefit of benznidazole in patients with Chagas cardiopathy. Thus, there is an urgent need not only of new therapeutic options but also of further evidence of the utility of benznidazole, at least in those patients with less severe disease. We conducted an observational study in the NIH SaMi-Trop cohort comparing patients with self-reported previous treatment with benznidazole with non-treated ones, using as primary outcome death in the follow-up of 2 years, and as secondary outcomes markers of severity based in the ECG and NT-proBNP levels, as well as parasitemia by PCR for Trypanosoma cruzi DNA in blood. Patients previously treated with benznidazole had significantly reduced parasitemia, a lower frequency of markers of severe cardiomyopathy and reduced mortality. If used in the early phases of Chagas disease, benznidazole treatment may result in better clinical and parasitological outcomes. It is reasonable to consider treating all Chagas disease patients without advanced cardiopathy with benznidazole, especially those less than 50 years-old of age.

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