Use of benznidazole to treat chronic Chagas disease: An updated systematic review with a meta-analysis

Abstract

Background Approximately 6 million people worldwide are affected by Chagas disease, with many in the chronic phase of the disease (CCD). It is crucial to evaluate the effectiveness of benznidazole for CCD treatment. Methods/Principal findings We updated a meta-analysis published in 2009 up to February 2021, including controlled trials (RCT) and prospective observational studies (OBS) that compared benznidazole vs placebo/no-treatment (P/nT). Main outcomes evaluated were clinical progression (CP) and seroreversion with subgroup analysis performed according to study design and participants’ age. Parasitological response and safety were also described. We identified 879 articles and selected nine for inclusion (corresponding to eight studies). After adding the nine articles from the previous meta-analysis, 17 studies were analyzed corresponding to 6640 patients. The odds ratio (OR) for seroreversion in children treated with benznidazole vs P/nT was 38.3 (95%CI: 10.7–137) and 34.9 (95%CI: 1.96–624.09) in RCT and OBS, respectively. In adults the OR for seroreversion in OBS was 17.1 (95%CI: 2.3–129.1). CP was only evaluated in adults, where benznidazole did not demonstrate a beneficial effect: OR 0.93 (95%CI: 0.8–1.1) and OR 0.49 (95%CI:0.2–1.2) for RCT and OBS, respectively. Most outcomes were deemed to have a low level of certainty, except for the beneficial effect in children and the low efficacy in adults (moderate certainty). Conclusions Benznidazole should be recommended for CCD in children, though this is only based on serological response and a moderate grade of evidence, while in adults benznidazole efficacy remains uncertain. More data on clinical efficacy of benznidazole in CCD is needed in both children and adults.

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

“…Vale finalmente ressaltar que, quando da elaboração final do presente capítulo, publicou-se atualização de antiga revisão sistemática e respectiva meta-análise relativamente a estudos de tratamento etiológico com benznidazol para pessoas com infecção por T. cruzi . 588 As conclusões essenciais dessa publicação são de molde a ter coerência com as recomendações aqui exaradas na Diretriz Brasileira. Entretanto, reitera-se que, no atual momento, para além da busca de evidências científicas mais robustas, todos os esforços devem ser envidados para a garantia de acesso a diagnóstico e tratamento etiológico da DC nos sistemas nacionais de saúde.…”

Synthesis and in vitro biological activity of chalcone derivatives as potential antiparasitic agents

“…Benznidazole, favored for its superior safety profile, is typically the primary choice [26]. It is administered orally with daily doses of 5 mg/kg for adults and 7.5 mg/kg for children over 60 days [27].…”

Chagas disease is related to structural changes of the gut microbiota in adults with chronic infection (TRIPOBIOME Study)

“…Their safety and efficacy profiles are far from ideal and are influenced principally by the infection's phase and the age of the patients. While the efficacy of benznidazole is high in the acute phase, congenital infections and reactivations in immunosuppressed individuals, cure rates drop significantly to 5-8% in the late chronic phase or in patients with cardiac involvement [16][17][18].…”