Benznidazole for Chronic Chagas Cardiomyopathy

Summary and Comment |
September 2, 2015

Benznidazole for Chronic Chagas Cardiomyopathy

  1. Kirsten E. Fleischmann, MD, MPH

Does trypanocidal therapy really help clinical outcomes?

  1. Kirsten E. Fleischmann, MD, MPH

Trypanosoma cruzi can cause both acute disease and a more chronic cardiomyopathy. To find out whether trypanocidal therapy kills the parasite or improves outcomes in chronic disease, researchers randomized 2854 patients with chronic Chagas cardiomyopathy to benznidazole or placebo for up to 80 days.

Polymerase-chain-reaction assays were used to document subjects' serostatus for the parasite, which was present in 61% of participants at baseline. By the end of treatment, conversion to seronegative status occurred in 66% of patients receiving benznidazole and 34% of those receiving placebo, a significant difference that continued at ≥5 years of follow-up. However, the two groups showed no significant differences in the combined primary outcome of adverse events or its components, including death, significant arrhythmia, new or worsening heart failure, embolic events, or cardiac transplantation.

Comment

In this well-conducted randomized trial, trypanocidal therapy improved seroconversion but did not improve clinical outcomes, at least in chronic disease. The authors note that autoimmune damage has been postulated as an important component of late disease and that their results do not necessarily apply to earlier phases of the disease. Interestingly, rates of seroconversion varied by geographic area, which may be a proxy for the various genetic subtypes of T. cruzi.

Editor Disclosures at Time of Publication

  • Disclosures for Kirsten E. Fleischmann, MD, MPH at time of publication Grant / Research support NIH/NHLBI; Bluefield Project to Cure Frontotemporal Dementia Leadership positions in professional societies American College of Cardiology and American Heart Association (Vice Chair, Writing Committee for Guidance on Cardiovascular Evaluation and Care for Noncardiac Surgery)

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