Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil

Abstract

Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies.

Estudo Longitudinal De Indivíduos Com Doença De Chagas De Região Endêmica Brasileira: A Coorte Samitrop

“…As variáveis do histórico médico que apresentaram associação com o óbito foram presença de hipertensão arterial, não uso prévio de BZN, ser portador de marca-passo, classe funcional com limitação e NT-proBNP alterado. Tais eventos estão relacionados ao possível agravamento da DC e ao dano cardíaco 32 , conforme já discutido. A classe funcional categoriza a extensão da insuficiência cardíaca, sendo que indivíduos sem limitação não apresentam restrição funcional em suas atividades rotineiras 33 .…”

“…A classe funcional categoriza a extensão da insuficiência cardíaca, sendo que indivíduos sem limitação não apresentam restrição funcional em suas atividades rotineiras 33 . A associação da classe funcional com o pior prognóstico da DC também já foi reconhecida 32 . O BZN é o único medicamento antiparasitário que age no T. cruzi, permitido para comercialização no Brasil 34 .…”

“…O BZN é o único medicamento antiparasitário que age no T. cruzi, permitido para comercialização no Brasil 34 . Estudos prévios verificaram que o uso do BZN esteve associado a uma redução significativa da parasitemia 32 , menor prevalência de marcadores de cardiomiopatia grave e menor mortalidade, enquanto o não uso do BZN aumentou a chance de eventos cardiovasculares 13 . Sendo assim, os achados da coorte SaMi-Trop, também, evidenciam que a gravidade clínica do portador de DC é associada ao óbito 35 .…”

Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort

“…Not using BZN also increased the probability of experiencing cardiovascular events, but the p value observed in this association was borderline (p = 0.057) and this result needs to be analyzed with caution. Previous use of this drug is still considered reduced among patients with CD in Brazilian endemic regions (27%) [15]. Previous studies have found that BZN use has been associated with a significant reduction in parasitemia [32], lower prevalence of severe cardiomyopathy markers, and lower mortality [48].…”

“…The SaMi-Trop methodology has been presented in detail in previous publications [14,15]. The main points of the methodology of this cohort are described in the following paragraphs.…”