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Gabaldón-Figueira JC, Martinez-Peinado N, Escabia E, Ros-Lucas A, Chatelain E, Scandale I, Gascon J, Pinazo MJ, Alonso-Padilla J. State-of-the-Art in the Drug Discovery Pathway for Chagas Disease: A Framework for Drug Development and Target Validation. Res Rep Trop Med 2023; 14:1-19. [PMID: 37337597 PMCID: PMC10277022 DOI: 10.2147/rrtm.s415273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023] Open
Abstract
Chagas disease is the most important protozoan infection in the Americas, and constitutes a significant public health concern throughout the world. Development of new medications against its etiologic agent, Trypanosoma cruzi, has been traditionally slow and difficult, lagging in comparison with diseases caused by other kinetoplastid parasites. Among the factors that explain this are the incompletely understood mechanisms of pathogenesis of T. cruzi infection and its complex set of interactions with the host in the chronic stage of the disease. These demand the performance of a variety of in vitro and in vivo assays as part of any drug development effort. In this review, we discuss recent breakthroughs in the understanding of the parasite's life cycle and their implications in the search for new chemotherapeutics. For this, we present a framework to guide drug discovery efforts against Chagas disease, considering state-of-the-art preclinical models and recently developed tools for the identification and validation of molecular targets.
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Affiliation(s)
| | - Nieves Martinez-Peinado
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Elisa Escabia
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Albert Ros-Lucas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - Eric Chatelain
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Ivan Scandale
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
| | - María-Jesús Pinazo
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Julio Alonso-Padilla
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (CIBERINFEC, ISCIII), Madrid, Spain
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Abstract
PURPOSE OF THE REVIEW This review examines the most recent literature on the epidemiology and treatment of Chagas Disease and the risk of Chagas Disease Reactivation and donor-derived disease in solid organ transplant recipients. RECENT FINDINGS Chagas disease is caused by infection with the parasite Trypansoma cruzi . In nonendemic countries the disease is seen primarily in immigrants from Mexico, Central America and South America where the disease is endemic. Benznidazole or nifurtimox can be used for treatment. Posaconazole and fosravuconazole did not provide any additional benefit compared to benznidazole alone or in combination. A phase 2 randomized controlled trial suggests that shorter or reduced dosed regimes of benznidazole could be used. Based on a large randomized controlled trial, benznidazole is unlikely to have a significant preventive effect for established Chagas cardiomyopathy. Transplantation has become the treatment of choice for individuals with refractory Chagas cardiomyopathy. Cohort studies show similar posttransplant outcomes for these patients compared to other indications. Transplant candidates and donors with chronic T. cruzi infection are at risk for Chagas disease reactivation and transmitting infection. Screening them via serology is the first line of prevention. Recipients with chronic infection and those receiving organs from infected donors should undergo sequential monitoring with polymerase chain reaction for early detection of reactivation and preemptive treatment with antitrypanosomal therapy. SUMMARY Patients with chronic T. cruzi infection can be safely transplanted and be noncardiac organ donors.
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Bustamante C, Díez-Mejía AF, Arbeláez N, Soares MJ, Robledo SM, Ochoa R, Varela-M. RE, Marín-Villa M. In Silico, In Vitro, and Pharmacokinetic Studies of UBMC-4, a Potential Novel Compound for Treating against Trypanosoma cruzi. Pathogens 2022; 11:pathogens11060616. [PMID: 35745470 PMCID: PMC9229894 DOI: 10.3390/pathogens11060616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 12/10/2022] Open
Abstract
The lack of therapeutic alternatives for the treatment of Chagas disease, a neglected disease, drives the discovery of new drugs with trypanocidal activity. Consequently, we conducted in vitro studies using UBMC-4, a potential Trypanosoma cruzi AKT-like pleckstrin homology (PH) domain inhibitory compound found using bioinformatics tools. The half effective concentration (EC50) on intracellular amastigotes was determined at 1.85 ± 1 μM showing low cytotoxicity (LC50) > 40 μM on human cell lines tested. In order to study the lethal effect caused by the compound on epimastigotes, morphological changes were assessed by scanning and transmission electron microscopy. Progressive alterations such as flagellum inactivation, cell size reduction, nuclear structure alteration, condensation of chromatin towards the nuclear periphery, vacuole formation, and mitochondrial swelling with kinetoplast integrity loss were evidenced. In addition, apoptosis-like markers in T. cruzi were assessed by flow cytometry, demonstrating that the effect of UBMC-4 on T. cruzi AKT-like kinase reduced the tolerance to nutritional stress-triggered, apoptosis-like events, including DNA fragmentation, mitochondrial damage, and loss of plasma membrane integrity. After this, UBMC-4 was formulated for oral administration and pharmacokinetics were analyzed in a mouse model. Finally, upon oral administration of 200 mg/kg in mice, we found that a UBMC-4 plasma concentration remaining in circulation beyond 24 h after administration is well described by the two-compartment model. We conclude that UBMC-4 has an effective trypanocidal activity in vitro at low concentrations and this effect is evident in T. cruzi cell structures. In mice, UBMC-4 was well absorbed and reached plasma concentrations higher than the EC50, showing features that would aid in developing a new drug to treat Chagas disease.
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Affiliation(s)
- Christian Bustamante
- PECET-Programa de Estudio y Control de Enfermedades Tropicales, School of Medicine, Universidad de Antioquia, Medellín 050010, Colombia; (A.F.D.-M.); (N.A.); (S.M.R.)
- Correspondence: (C.B.); (M.M.-V.)
| | - Andrés Felipe Díez-Mejía
- PECET-Programa de Estudio y Control de Enfermedades Tropicales, School of Medicine, Universidad de Antioquia, Medellín 050010, Colombia; (A.F.D.-M.); (N.A.); (S.M.R.)
| | - Natalia Arbeláez
- PECET-Programa de Estudio y Control de Enfermedades Tropicales, School of Medicine, Universidad de Antioquia, Medellín 050010, Colombia; (A.F.D.-M.); (N.A.); (S.M.R.)
| | - Maurilio José Soares
- Cell Biology Laboratory, Carlos Chagas Institute/Fiocruz, Curitiba 81350-010, Paraná, Brazil;
| | - Sara M. Robledo
- PECET-Programa de Estudio y Control de Enfermedades Tropicales, School of Medicine, Universidad de Antioquia, Medellín 050010, Colombia; (A.F.D.-M.); (N.A.); (S.M.R.)
| | - Rodrigo Ochoa
- Biophysics of Tropical Diseases, Max Planck Tandem Group, Universidad de Antioquia, Medellín 050010, Colombia;
| | - Rubén E. Varela-M.
- Grupo (QUIBIO), School of Basic Sciences, Universidad Santiago de Cali, Cali 760032, Colombia;
| | - Marcel Marín-Villa
- PECET-Programa de Estudio y Control de Enfermedades Tropicales, School of Medicine, Universidad de Antioquia, Medellín 050010, Colombia; (A.F.D.-M.); (N.A.); (S.M.R.)
- Correspondence: (C.B.); (M.M.-V.)
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Chakravarti I, Miranda-Schaeubinger M, Ruiz-Remigio A, Briones-Garduño C, Fernández-Figueroa EA, Villanueva-Cabello CC, Borge-Villareal A, Bejar-Ramírez Y, Pérez-González A, Rivera-Benitez C, Oren E, Brown HE, Becker I, Gilman RH. Chagas Disease in Pregnant Women from Endemic Regions Attending the Hospital General de Mexico, Mexico City. Trop Med Infect Dis 2022; 7:8. [PMID: 35051124 PMCID: PMC8779423 DOI: 10.3390/tropicalmed7010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/01/2023] Open
Abstract
Trypanosoma cruzi infection leads to Chagas disease (CD), a neglected tropical infection of significant public health importance in South and Central America and other, non-endemic, countries. Pregnant women and their children are of particular importance to screen as T. cruzi can be transmitted vertically. The objective of this study was to screen for T. cruzi infection among pregnant women from endemic areas seen at the Hospital General de Mexico for prenatal care, so that they and their children may be quickly connected to CD treatment. Pregnant women were recruited through the hospital prenatal clinic and screened for T. cruzi infection using a series of serological and molecular tests. Of 150 screened patients, mean age 26.8 (SD 6.4), 30 (20.0%) were positive by at least one diagnostic test. Of these, only nine (6%) were positive as determined by PCR. Diagnosis of chronic CD is difficult in endemic places like Mexico due to the limitations of current commercially available diagnostic tests. Further evaluation of diagnostic performance of various assays could improve current CD diagnostic algorithms and proper care management in these regions. Genetic variability in the parasite may also play a role in the differing assay performances seen in this study, and this may be a valuable avenue of further research.
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Affiliation(s)
- Indira Chakravarti
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21215, USA;
| | | | - Adriana Ruiz-Remigio
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
| | - Carlos Briones-Garduño
- Servicio de Ginecología y Obstetricia, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (C.B.-G.); (A.B.-V.)
| | - Edith A. Fernández-Figueroa
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
- Computational and Integrative Genomics, National Institute of Genomic Medicine, Ciudad de México 14610, Mexico
| | - Concepción Celeste Villanueva-Cabello
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
| | - Alejandra Borge-Villareal
- Servicio de Ginecología y Obstetricia, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (C.B.-G.); (A.B.-V.)
| | - Yadira Bejar-Ramírez
- Banco de Sangre, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (Y.B.-R.); (A.P.-G.)
| | - Alejandro Pérez-González
- Banco de Sangre, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico; (Y.B.-R.); (A.P.-G.)
| | - César Rivera-Benitez
- Servicio de Infectología, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México 06720, Mexico;
| | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA;
| | - Heidi E. Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Ingeborg Becker
- Centro de Medicina Tropical, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (A.R.-R.); (E.A.F.-F.); (C.C.V.-C.)
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21215, USA;
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Torrico F, Gascón J, Barreira F, Blum B, Almeida IC, Alonso-Vega C, Barboza T, Bilbe G, Correia E, Garcia W, Ortiz L, Parrado R, Ramirez JC, Ribeiro I, Strub-Wourgaft N, Vaillant M, Sosa-Estani S. New regimens of benznidazole monotherapy and in combination with fosravuconazole for treatment of Chagas disease (BENDITA): a phase 2, double-blind, randomised trial. THE LANCET. INFECTIOUS DISEASES 2021; 21:1129-1140. [PMID: 33836161 DOI: 10.1016/s1473-3099(20)30844-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/10/2020] [Accepted: 10/14/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current treatment for Chagas disease with the only available drugs, benznidazole or nifurtimox, has substantial limitations, including long treatment duration and safety and tolerability concerns. We aimed to evaluate the efficacy and safety of new benznidazole monotherapy regimens and combinations with fosravuconazole, in the treatment of Chagas disease. METHODS We did a double-blind, double-dummy, phase 2, multicentre, randomised trial in three outpatient units in Bolivia. Adults aged 18-50 years with chronic indeterminate Chagas disease, confirmed by serological testing and positive qualitative PCR results, were randomly assigned (1:1:1:1:1:1:1) to one of seven treatment groups using a balanced block randomisation scheme with an interactive response system. Participants were assigned to benznidazole 300 mg daily for 8 weeks, 4 weeks, or 2 weeks, benznidazole 150 mg daily for 4 weeks, benznidazole 150 mg daily for 4 weeks plus fosravuconazole, benznidazole 300 mg once per week for 8 weeks plus fosravuconazole, or placebo, with a 12-month follow-up period. The primary endpoints were sustained parasitological clearance at 6 months, defined as persistent negative qualitative PCR results from end of treatment, and incidence and severity of treatment-emergent adverse events, serious adverse events, and adverse events leading to treatment discontinuation. Primary efficacy analysis was based on the intention-to-treat and per-protocol populations and secondary efficacy analyses on the per-protocol population. Safety analyses were based on the as-treated population. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT03378661. FINDINGS Between Nov 30, 2016, and July 27, 2017, we screened 518 patients, and 210 were enrolled and randomised. 30 patients (14%) were assigned to each treatment group. All 210 randomised patients were included in the intention-to-treat population, and 190 (90%) were included in the per-protocol population. In the intention-to-treat analysis, only one (3%) of 30 patients in the placebo group had sustained parasitological clearance at 6 months of follow-up. Sustained parasitological clearance at 6 months was observed in 25 (89%) of 28 patients receiving benznidazole 300 mg daily for 8 weeks (rate difference vs placebo 86% [95% CI 73-99]), 25 (89%) of 28 receiving benznidazole 300 mg daily for 4 weeks (86% [73-99]), 24 (83%) of 29 receiving benznidazole 300 mg daily for 2 weeks (79% [64-95]), 25 (83%) of 30 receiving benznidazole 150 mg daily for 4 weeks (80% [65-95]), 23 (85%) of 28 receiving benznidazole 150 mg daily for 4 weeks plus fosravuconazole (82% [67-97]), and 24 (83%) of 29 receiving benznidazole 300 mg weekly for 8 weeks plus fosravuconazole (79% [64-95]; p<0·0001 for all group comparisons with placebo). Six patients (3%) had ten serious adverse events (leukopenia [n=3], neutropenia [n=2], pyrexia, maculopapular rash, acute cholecystitis, biliary polyp, and breast cancer), eight had 12 severe adverse events (defined as interfering substantially with the patient's usual functions; elevated alanine aminotransferase [n=4], elevated gamma-glutamyltransferase [n=2], elevated aspartate aminotransferase [n=1], neutropenia [n=3], leukopenia [n=1], and breast cancer [n=1]), and 15 (7%) had adverse events that led to treatment discontinuation (most of these were in the groups who received benznidazole 300 mg daily for 8 weeks, benznidazole 300 mg once per week for 8 weeks plus fosravuconazole, and benznidazole 150 mg daily for 4 weeks plus fosravuconazole). No adverse events leading to treatment discontinuation were observed in patients treated with benznidazole 300 mg daily for 2 weeks or placebo. There were no treatment-related deaths. INTERPRETATION Benznidazole induced effective antiparasitic response, regardless of treatment duration, dose, or combination with fosravuconazole, and was well tolerated in adult patients with chronic Chagas disease. Shorter or reduced regimens of benznidazole could substantially improve treatment tolerability and accessibility, but further studies are needed to confirm these results. FUNDING Drugs for Neglected Diseases initiative (DNDi). TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Faustino Torrico
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia; Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Joaquim Gascón
- Barcelona Institute for Global Health, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Cristina Alonso-Vega
- Barcelona Institute for Global Health, Barcelona, Spain; DNDi Latin America, Rio de Janeiro, Brazil
| | | | - Graeme Bilbe
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Wilson Garcia
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia
| | - Lourdes Ortiz
- Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES), Cochabamba, Bolivia; Juan Misael Saracho Autonomous University, Tarija, Bolivia
| | - Rudy Parrado
- Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Juan Carlos Ramirez
- Instituto Nacional de Parasitología "Dr Mario Fatala Chaben" (INP-ANLIS), Buenos Aires, Argentina
| | - Isabela Ribeiro
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | | | - Sergio Sosa-Estani
- DNDi Latin America, Rio de Janeiro, Brazil; Epidemiology and Public Health Research Centre, CONICET, Buenos Aires, Argentina.
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Parisi S, Navarro M, Du Plessis JD, Shock JP, Apodaca Michel B, Lucuy Espinoza M, Terán C, Calizaya Tapia NA, Oltmanns K, Baptista Mora A, Saveedra Irala C, Rivera Rojas AA, Rubilar G, Zoller T, Pritsch M. "We have already heard that the treatment doesn't do anything, so why should we take it?": A mixed method perspective on Chagas disease knowledge, attitudes, prevention, and treatment behaviour in the Bolivian Chaco. PLoS Negl Trop Dis 2020; 14:e0008752. [PMID: 33119632 PMCID: PMC7595318 DOI: 10.1371/journal.pntd.0008752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is highly endemic in the Bolivian Chaco. The municipality of Monteagudo has been targeted by national interventions as well as by Médecins Sans Frontières to reduce infection rates, and to decentralize early diagnosis and treatment. This study seeks to determine the knowledge and attitudes of a population with increased awareness and to identify remaining factors and barriers for sustained vector control, health care seeking behaviour, and access, in order to improve future interventions. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional survey was conducted among approximately 10% (n = 669) of the municipality of Monteagudo's households that were randomly selected. Additionally, a total of 14 in-depth interviews and 2 focus group discussions were conducted with patients and key informants. Several attitudes and practices were identified that could undermine effective control against (re-)infection. Knowledge of clinical symptoms and secondary prevention was limited, and revealed specific misconceptions. Although 76% of the participants had been tested for CD, only 18% of those who tested positive concluded treatment with benznidazole (BNZ). Sustained positive serologies after treatment led to perceived ineffectiveness of BNZ. Moreover, access barriers such as direct as well as indirect costs, BNZ stock-outs and a fear of adverse reactions triggered by other community members made patients opt for alternative treatments against CD such as veterinary ivermectin, used by 28% of infected participants in our study. The lack of accessible care for chronic complications as well as socioeconomic consequences, such as the exclusion from both job opportunities and bank loans contributed to the ongoing burden of CD. CONCLUSIONS/SIGNIFICANCE Large scale interventions should be accompanied by operational research in order to identify misconceptions and unintended consequences early on, to generate accessible data for future interventions, and for rigorous evaluation. An integrated, community-based approach tackling social determinants and including both traditional and animal health sectors might help to overcome current barriers and advocate for patients' rights.
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Affiliation(s)
- Sandra Parisi
- Institute of Tropical Medicine and International Health, Charité –Universitätsmedizin Berlin, Berlin, Germany
- DAHW Deutsche Lepra- und Tuberkulosehilfe e. V., Würzburg, Germany
- Department of General Practice, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Jonathan Phillip Shock
- Department of Maths and Applied Maths, University of Cape Town, Rondebosch, South Africa
| | - Boris Apodaca Michel
- Hospital Dermatológico Monteagudo, Monteagudo, Bolivia
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Minerva Lucuy Espinoza
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | - Carolina Terán
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | | | - Katharina Oltmanns
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Abundio Baptista Mora
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | - Claudia Saveedra Irala
- Hospital Dermatológico Monteagudo, Monteagudo, Bolivia
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Angel Alberto Rivera Rojas
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Gonzalo Rubilar
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Thomas Zoller
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
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7
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Koovits PJ, Dessoy MA, Matheeussen A, Maes L, Caljon G, Mowbray CE, Kratz JM, Dias LC. Structure-activity relationship of 4-azaindole-2-piperidine derivatives as agents against Trypanosoma cruzi. Bioorg Med Chem Lett 2019; 30:126779. [PMID: 31706667 DOI: 10.1016/j.bmcl.2019.126779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
The structure-activity relationship of a 4-Azaindole-2-piperidine compound selected from GlaxoSmithKline's recently disclosed open-resource "Chagas box" and possessing moderate activity against Trypanosoma cruzi, the parasite responsible for Chagas disease, is presented. Despite considerable medicinal chemistry efforts, a suitably potent and metabolically stable compound could not be identified to advance the series into in vivo studies. This research should be of interest to those in the area of neglected diseases and in particular anti-kinetoplastid drug discovery.
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Affiliation(s)
- Paul J Koovits
- Institute of Chemistry, University of Campinas (UNICAMP), Rua Josué de Castro, S/N, Cidade Universitária, Campinas, SP 13083-861, Brazil
| | - Marco A Dessoy
- Institute of Chemistry, University of Campinas (UNICAMP), Rua Josué de Castro, S/N, Cidade Universitária, Campinas, SP 13083-861, Brazil
| | - An Matheeussen
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - Louis Maes
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - Guy Caljon
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - Charles E Mowbray
- Drugs for Neglected Diseases Initiative (DNDi), 15 Chemin Louis-Dunant, 1202 Geneva, Switzerland
| | - Jadel M Kratz
- Drugs for Neglected Diseases Initiative (DNDi), 15 Chemin Louis-Dunant, 1202 Geneva, Switzerland
| | - Luiz C Dias
- Institute of Chemistry, University of Campinas (UNICAMP), Rua Josué de Castro, S/N, Cidade Universitária, Campinas, SP 13083-861, Brazil.
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Crespillo-Andújar C, Venanzi-Rullo E, López-Vélez R, Monge-Maillo B, Norman F, López-Polín A, Pérez-Molina JA. Safety Profile of Benznidazole in the Treatment of Chronic Chagas Disease: Experience of a Referral Centre and Systematic Literature Review with Meta-Analysis. Drug Saf 2019; 41:1035-1048. [PMID: 30006773 DOI: 10.1007/s40264-018-0696-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Benznidazole is the preferred drug for treatment of Chagas disease. However, it is toxic and of limited value in chronic infection. OBJECTIVE We aimed to estimate the rates of and factors related to adverse reactions (ARs) to benznidazole and treatment discontinuations (TDs). METHODS A meta-analysis was performed using an electronic search of the published literature with no language restrictions until June 2017. Prospective studies were included of chronically infected patients in which at least one treatment arm included benznidazole. Data were added from a prospective cohort of patients with Chagas disease at our centre (January 2007-June 2017). Weighted rates of ARs and TDs were estimated, and potentially related factors were analysed. RESULTS Some 413 studies were found, from which we chose 42 (nine clinical trials and 33 observational studies, including ours), comprising data for 7822 patients. The weighted rate of ARs to benznidazole was 44.1% (95% confidence interval [CI] 37.2-51.2). ARs were more frequent in adults than in children (51.6 vs. 24.5%), with the most common being skin reactions (34%), gastrointestinal complaints (12.6%) and neurological symptoms (11.5%). Grade 4 ARs were recorded in 3% of cases. The weighted rate of TDs was 11.4% (95% CI 8.5-14.5); TDs were more frequent in adults than in children (14.2 vs. 3.8%). In our cohort, only female sex was related to an increased rate of ARs but not to TDs. CONCLUSION Benznidazole had a poor tolerability profile, with a high incidence of TDs, especially in adult patients and women. Optimised dosing schedules and/or new drugs are urgently needed.
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Affiliation(s)
- Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Emmanuele Venanzi-Rullo
- Division of Infectious Diseases, University of Messina, Polyclinic "G. Martino", Messina, Italy
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - Francesca Norman
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - Ana López-Polín
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - José A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain.
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Chagas screening and treatment among Bolivians living in Madrid, Spain: The need for an official protocol. PLoS One 2019; 14:e0213577. [PMID: 30849113 PMCID: PMC6407767 DOI: 10.1371/journal.pone.0213577] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background It is estimated that around 52,000 people live with Chagas in Spain, but only 10% have been diagnosed. Migrants from Bolivia bear the burden of Chagas infection in Spain. However, little is known about their current management of Chagas diagnosis and treatment patterns. This study aimed to assess the Chagas related disease perception and health behaviour of Bolivians living in Madrid. Methods and principal findings For a first time, a cross-sectional survey about Chagas’ knowledges and practices was carried out in Madrid, Spain. A total of 376 Bolivians were interviewed about their Chagas health-seeking behaviour. Differences between men and women were assessed Most of Bolivians living in Madrid have access to the public health services. 44% of Bolivians included in the survey had a Chagas screening test done. However, while women did their test for Chagas mostly at hospital (59.2%), men also used the community campaigns (17.5%) and blood banks (14.3%). The prevalence reported among Bolivians tested was 27.7%. Unfortunately, more than half of those reporting a positive test for Chagas did not begin or completed treatment. Only 45.7% of positives reported having had their children tested for Chagas. Conclusions Despite the increase in the number of Chagas diagnoses done in Madrid, the number of Bolivians who tested positive and then started or completed treatment remains very low. The fact that most Bolivians’ access to the health system is through the primary healthcare services should be considered for improving management of cases and follow-up of treatment adherence. Local and national protocol establishing guidelines for the screening and treatment of Chagas disease would help improving case detection and management at all levels of the healthcare system.
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10
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Sperandio da Silva GM, Mediano MFF, Hasslocher-Moreno AM, Holanda MTD, Silvestre de Sousa A, Sangenis LHC, Brasil PEAAD, Mejía RA, Fux CP, Cubides JC, Saraiva RM, Brum-Soares LM. Benznidazole treatment safety: the Médecins Sans Frontières experience in a large cohort of Bolivian patients with Chagas' disease. J Antimicrob Chemother 2018. [PMID: 28645201 DOI: 10.1093/jac/dkx180] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Up to half of patients with Chagas' disease under benznidazole treatment present adverse drug reactions (ADRs) and up to one-third do not complete standard treatment. Objectives To verify the incidence and possible factors associated with the suspension of benznidazole treatment in a large cohort of patients. Methods We included 2075 patients treated with benznidazole during the projects managed by the medical humanitarian organization Doctors Without Borders (Médecins Sans Frontières) in Bolivia from 2009 to 2013. Benznidazole treatment was provided two or three times per day for ∼60 days at 5-7.5 mg/kg/day. A multiple logistic regression model was developed to evaluate the factors associated with permanent suspension of benznidazole treatment. Results Permanent benznidazole treatment suspension occurred in 211 patients (10.2%) and the average time until permanent treatment suspension was 23 days. Multifactorial analysis revealed that female sex (adjusted OR = 1.70), moderate ADRs (adjusted OR = 10.57), mild ADRs (adjusted OR = 1.69) and skin disorders (adjusted OR = 4.18) were significantly associated with the permanent suspension of benznidazole treatment. Women with mild or moderate skin ADRs presented a probability of treatment interruption of 18.6% and 59.0%, respectively. Conclusions Benznidazole treatment was safe and a large proportion of patients were able to complete a full course of benznidazole treatment under close treatment surveillance. Female sex, skin disorders and mild and moderate ADRs were independently associated with the permanent suspension of benznidazole treatment. In particular, women with moderate skin ADRs had the highest risk of benznidazole treatment interruption.
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Affiliation(s)
| | - M F F Mediano
- Evandro Chagas National Institute of Infectious Diseases (INI)-Oswaldo Cruz Foundation (Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | | | - Marcelo Teixeira de Holanda
- Evandro Chagas National Institute of Infectious Diseases (INI)-Oswaldo Cruz Foundation (Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | - Andrea Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases (INI)-Oswaldo Cruz Foundation (Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | - Luiz Henrique Conde Sangenis
- Evandro Chagas National Institute of Infectious Diseases (INI)-Oswaldo Cruz Foundation (Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | | | - Roger Arteaga Mejía
- Médecins Sans Frontières (MSF), Operational Center Barcelona (OCBA), 08001 Barcelona, Spain
| | - Carina Perotti Fux
- Médecins Sans Frontières (MSF), Operational Center Barcelona (OCBA), 08001 Barcelona, Spain
| | - Juan-Carlos Cubides
- Médecins Sans Frontières (MSF), Brazilian Medical Unit (BRAMU), Glória, Rio de Janeiro, Brazil
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Diseases (INI)-Oswaldo Cruz Foundation (Fiocruz), Manguinhos, Rio de Janeiro, Brazil
| | - Lucia Maria Brum-Soares
- Médecins Sans Frontières (MSF), Brazilian Medical Unit (BRAMU), Glória, Rio de Janeiro, Brazil
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Priegue M, Almuedo A, Rodríguez I, Rovira O, Soler N, Pardo C, Pola N, Mas P, Modamio P, Mariño EL. Pharmacist intervention in patients receiving treatment for Chagas disease: An emerging challenge for non-endemic countries. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Sartor P, Colaianni I, Cardinal MV, Bua J, Freilij H, Gürtler RE. Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation. PLoS Negl Trop Dis 2017; 11:e0005336. [PMID: 28192425 PMCID: PMC5325580 DOI: 10.1371/journal.pntd.0005336] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 02/24/2017] [Accepted: 01/18/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rural populations in the Gran Chaco region have large prevalence rates of Trypanosoma cruzi infection and very limited access to diagnosis and treatment. We implemented an innovative strategy to bridge these gaps in 13 rural villages of Pampa del Indio held under sustained vector surveillance and control. METHODOLOGY The non-randomized treatment program included participatory workshops, capacity strengthening of local health personnel, serodiagnosis, qualitative and quantitative PCRs, a 60-day treatment course with benznidazole and follow-up. Parents and healthcare agents were instructed on drug administration and early detection and notification of adverse drug-related reactions (ADR). Healthcare agents monitored medication adherence and ADRs at village level. PRINCIPAL FINDINGS The seroprevalence of T. cruzi infection was 24.1% among 395 residents up to 18 years of age examined. Serodiagnostic (70%) and treatment coverage (82%) largely exceeded local historical levels. Sixty-six (85%) of 78 eligible patients completed treatment with 97% medication adherence. ADRs occurred in 32% of patients, but most were mild and manageable. Four patients showing severe or moderate ADRs required treatment withdrawal. T. cruzi DNA was detected by qPCR in 47 (76%) patients before treatment, and persistently occurred in only one patient over 20-180 days posttreatment. CONCLUSIONS AND SIGNIFICANCE Our results demonstrate that diagnosis and treatment of T. cruzi infection in remote, impoverished rural areas can be effectively addressed through strengthened primary healthcare attention and broad social participation with adequate external support. This strategy secured high treatment coverage and adherence; effectively managed ADRs, and provided early evidence of positive therapeutic responses.
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Affiliation(s)
- Paula Sartor
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Dirección de Epidemiología, Ministerio de Salud de la Provincia del Chaco, Chaco, Argentina.,Programa Nacional de Chagas, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Ivana Colaianni
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.,Hospital Santojanni, Buenos Aires, Argentina
| | - M Victoria Cardinal
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología "Dr. M. Fatala Chaben", ANLIS C.G. Malbrán, Buenos Aires, Argentina
| | - Héctor Freilij
- Programa Nacional de Chagas, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Ricardo E Gürtler
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
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13
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Ferreira AM, Sabino EC, de Oliveira LC, Oliveira CDL, Cardoso CS, Ribeiro ALP, Haikal DS. Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil. PLoS One 2016; 11:e0165950. [PMID: 27855177 PMCID: PMC5113907 DOI: 10.1371/journal.pone.0165950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023] Open
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.
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Affiliation(s)
- Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Institute of the University of São Paulo, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Lea Campos de Oliveira
- Medical Investigation Laboratories-03 Clinics Hospital, Medical School, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais (Universidade Federal de Minas Gerais), Belo Horizonte, Minas Gerais, Brazil
| | - Desirée Sant’Ana Haikal
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
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El Alili M, Vrijens B, Demonceau J, Evers SM, Hiligsmann M. A scoping review of studies comparing the medication event monitoring system (MEMS) with alternative methods for measuring medication adherence. Br J Clin Pharmacol 2016; 82:268-79. [PMID: 27005306 DOI: 10.1111/bcp.12942] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022] Open
Abstract
Different methods are available for measuring medication adherence. In this paper, we conducted a scoping review to identify and summarize evidence of all studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. A literature search was performed using the open database www.iAdherence.org that includes all original studies reporting findings from the MEMS. Papers comparing methods for measuring adherence to solid oral formulations were included. Data was extracted using a standardized extraction table. A total of 117 articles fulfilled the inclusion criteria, including 251 comparisons. Most frequent comparisons were against self-report (n = 119) and pill count (n = 59). Similar outcome measures were used in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or not) and 132 used continuous measures (adherence expressed as percentage). Furthermore, 32% of all comparisons did not estimate adherence over the same coverage period and 44% of all comparisons did not use a statistical method or used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage periods, similar outcome measures and optimal statistical methods. Compared to MEMS, median adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating. In conclusion, among all comparisons of MEMS versus alternative methods for measuring adherence, only a few used adequate comparisons in terms of outcome measures, coverage periods and statistical method. Researchers should therefore use stronger methodological frameworks when comparing measurement methods and be aware that non-electronic measures could lead to overestimation of medication adherence.
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Affiliation(s)
- Mohamed El Alili
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Bernard Vrijens
- WestRock Healthcare, Visé, Belgium.,Department of Public Health, University of Liège, Liège, Belgium
| | | | - Silvia M Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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15
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Neglect of a Neglected Disease in Italy: The Challenge of Access-to-Care for Chagas Disease in Bergamo Area. PLoS Negl Trop Dis 2015; 9:e0004103. [PMID: 26406325 PMCID: PMC4583374 DOI: 10.1371/journal.pntd.0004103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Chagas disease (CD) represents a growing problem in Europe; Italy is one of the most affected countries but there is no national framework for CD and access-to-care is challenging. In 2012 Médecins Sans Frontières (MSF) started an intervention in Bergamo province, where many people of Latin American origin (PLAO) are resident. A new model-of-care for CD, initiated by Centre for Tropical Diseases of Sacro Cuore Hospital, Negrar (CTD), the NGO OIKOS and the Bolivian community since 2009 in the same area, was endorsed. Hereby, we aim to describe the prevalence of CD and the treatment management outcomes among PLAO screened from 1st June 2012 to 30th June 2013. METHODS Retrospective cohort study using routine program data. Screening sessions were done in Bergamo at OIKOS outpatient service and serological confirmation, staging and treatment for CD was offered at the CTD. MSF provided health education on CD, awareness generation prior to screening days, pre-test and post-test counselling through cultural mediators of Latin American origin. RESULTS Of 1305 PLAO screened, 223(17%) had CD. Among 210 patients eligible for treatment, 102(49%) were lost-to-follow-up before treatment. The median delay from diagnosis to treatment was 4 months (range 0.7-16.6 months). Among 108 started on treatment, 63(58%) completed treatment, 36(33%) interrupted treatment, (33 for drug side-effects, two for patients decision and one due to pregnancy), 6(6%) were lost-to-follow-up and 3(3%) were on treatment at study censuring. CONCLUSION In this first study focusing on process of care for CD in Italy, less than 30% of patients completed treatment with drop-outs along the cascade of care. There is an urgent need to involve affected communities and local regional health authorities to take part to this model-of-care, adapting it to the local epidemiology. The Italian health authorities should take steps in advocating for a change in the current paradigm.
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Pérez-Molina JA, Perez AM, Norman FF, Monge-Maillo B, López-Vélez R. Old and new challenges in Chagas disease. THE LANCET. INFECTIOUS DISEASES 2015; 15:1347-56. [PMID: 26231478 DOI: 10.1016/s1473-3099(15)00243-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 12/17/2022]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected disease, which can lead to cardiomyopathy, arrhythmias, megaviscera, and more rarely, polyneuropathy in up to 30-40% of patients around 20 to 30 years after acute infection. Although it is endemic in the Americas, global population movements mean that it can be located wherever migrants from endemic areas settle. The disease was first described 100 years ago and still challenges clinicians worldwide, since diagnostic, therapeutic, and prognostic methods remain insufficient. Furthermore, factors such as HIV co-infection, immunosuppressive drugs, transplantation, and neoplastic disease can alter the natural course of the infection. We present the case of a Bolivian woman with chronic T cruzi infection diagnosed at our clinic in Madrid, Spain, who subsequently developed non-Hodgkin lymphoma. Our report illustrates the challenges of an increasingly common infection seen in non-endemic countries, and highlights both daily management dilemmas and associated difficulties that arise.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain.
| | - Angela Martinez Perez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Francesca F Norman
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Insituto Ramón y Cajal de Investgación Sanitaria, Madrid, Spain
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Toxic Profile of Benznidazole in Patients with Chronic Chagas Disease: Risk Factors and Comparison of the Product from Two Different Manufacturers. Antimicrob Agents Chemother 2015. [PMID: 26195525 DOI: 10.1128/aac.04660-14] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Benznidazole is considered the first-line treatment option against Chagas disease. The major drawback of benznidazole is its toxicity profile. The main objectives of this study were to describe the adverse events (AEs) in patients with chronic Chagas disease treated with benznidazole, determine the risk factors involved and compare the toxic profiles of two different preparations of the drug from ELEA and Roche. A total of 746 patients were diagnosed with Chagas disease in a 5-year period, and of these 472 were treated with benznidazole. A high proportion of patients (n = 360 [76%]) suffered AEs, the most frequent being those related to hypersensitivity (52.9% of patients), headache (12.5%), and epigastric pain (10.4%). In 72 (12.7%) cases, treatment was discontinued. Overall, women had a higher incidence of AEs compared to men (81.3% versus 66%, P = 0.001) and were subject to higher levels of hypersensitivity-related events. Dermatological events, digestive tract manifestations, and general symptoms had a greater likelihood to appear around day 10 and neurological AEs around day 40 after starting treatment. With respect to liver function and hematological tests, the majority of patients did not suffer significant perturbation of liver enzymes or altered blood cell counts. However, 14 patients suffered from neutropenia, and 14 patients had aminotransferase levels that were more than four times the upper limit of the normal range. Patients treated with the ELEA benznidazole product experienced more arthromyalgia, neutropenia, and neurological disorders (mainly paresthesias) than those treated with the Roche product. Both drug products resulted in approximately the same percentage of permanent withdrawals.
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Antinori S, Grande R, Bianco R, Traversi L, Cogliati C, Torzillo D, Repetto E, Corbellino M, Milazzo L, Galli M, Galimberti L. High Frequency of Adverse Reactions and Discontinuation With Benznidazole Treatment for Chronic Chagas Disease in Milan, Italy. Clin Infect Dis 2015; 60:1873-5. [DOI: 10.1093/cid/civ230] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sperandio da Silva GM, Mediano MFF, Alvarenga Americano do Brasil PE, da Costa Chambela M, da Silva JA, de Sousa AS, Xavier SS, Rodrigues da Costa A, Magalhães Saraiva R, Hasslocher-Moreno AM. A clinical adverse drug reaction prediction model for patients with chagas disease treated with benznidazole. Antimicrob Agents Chemother 2014; 58:6371-7. [PMID: 25114135 PMCID: PMC4249401 DOI: 10.1128/aac.02842-14] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/05/2014] [Indexed: 01/28/2023] Open
Abstract
Benznidazole (BZN) is the main trypanocidal drug used to treat Chagas disease, and the evidence supporting the benefits of BZN use during the chronic phase of the disease will favor its use in millions of individuals. However, more than 30% of patients treated with BZN may suffer adverse drug reactions (ADRs), and the development of tools to identify those patients at risk is highly desirable. In the present study, we aimed to identify predictive factors for ADRs in Chagas disease patients treated with BZN. Among 195 patients included in the study, 48.7% experienced ADRs and 31.3% had ADRs that caused BZN treatment discontinuation. Overall ADRs and ADRs that caused BZN treatment discontinuation were more common among women and in those who graduated from elementary school. Overall ADRs were also less frequent among black individuals. Based on logistic regression analysis, female sex (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5 to 5.4), graduation from elementary school (OR, 2.0; 95% CI, 1.1 to 3.8), and white (OR, 5.0; 95% CI, 1.0 to 24.1) and mulatto (OR, 5.6; 95% CI, 1.1 to 28.7) races were considered to predict overall ADRs, and female sex (OR, 2.3; 95% CI, 1.2 to 4.3) was considered to predict ADRs that caused BZN treatment discontinuation. Graduation from elementary school also presented a tendency to predict ADRs that caused BZN treatment discontinuation (OR, 1.8; 95% CI, 0.9 to 3.6). The logistic regression (LR) models to predict ADRs to BZN described in this study may become important tools to minimize ADRs and improve patients' compliance and thus assist physicians treating patients with Chagas disease with BZN.
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Affiliation(s)
| | | | | | - Mayara da Costa Chambela
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Joyce Almeida da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrea Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sergio Salles Xavier
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrea Rodrigues da Costa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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