Journal Article

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

Busch, Michael P., Oliveira, Lea Campos, Reingold, Arthur Lawrence, Colosimo, Enrico Antonio, Sabino, Ester Cerdeira, Oliveira, Claudia Di Lorenzo, Silva, José Luiz Padilha, Lee, Tzong-Hae, Bierrenbach, Ana Luiza, Cardoso, Clareci Silva, Ferreira, Ariela Mota, Ferreira, João Eduardo, Ribeiro, Antonio Luiz P.

2018

Overview

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. 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. 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]. 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. ClinicalTrials.gov, Trial registration: NCT02646943.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abnormalities / Aftercare / Analysis / Automation / Benznidazole / Biology and Life Sciences / Brazil - epidemiology / Cardiomyopathy / Cardiovascular diseases / Care and treatment / Chagas disease / Chagas Disease - complications / Chagas Disease - drug therapy / Chagas Disease - mortality / Chagas Disease - parasitology / Chronic Disease - drug therapy / Cities and towns / Clinical trials / Cohort analysis / Cohorts / Congestive heart failure / Coronary artery disease / Corporate sponsorship / Disease / Diseases / DNA / Echocardiography / EKG / Electrocardiography / Follow-Up Studies / Funding / Heart / Heart failure / Hospitals / Humans / Malformations / Medical research / Medical treatment / Medicine / Medicine and Health Sciences / Mortality / Myocardial diseases / National Institutes of Health (U.S.) / Nitroimidazoles - administration & dosage / Nitroimidazoles - adverse effects / Nucleotide sequence / Parasitemia / Parasitemia - epidemiology / Parasitemia - etiology / Parasites / Patient outcomes / Patients / PCR / Peptides / Primary care / Prospective Studies / Research and Analysis Methods / Risk factors / Treatment outcome / Tropical diseases / Trypanocidal Agents - administration & dosage / Trypanosoma cruzi - drug effects / Trypanosoma cruzi - physiology / United States / Vector-borne diseases