Less Is More

Less Is More

A clinical trial carried out in Bolivia finds that a shorter treatment for Chagas disease is as effective as the standard regimen, and much safer

The only two drugs currently available to treat Chagas disease were developed decades ago and have frequent side effects.

The only two drugs currently available to treat Chagas disease were developed decades ago and have frequent side effects.

Chagas disease affects an estimated six million people globally, and, if not treated, can cause irreversible life-threatening damage to the heart and other organs. The only two drugs (nifurtimox and benznidazole) known to be effective against Trypanosoma cruzi, the parasite that causes Chagas disease, were developed decades ago, involve long treatments (60 days or more) and have frequent side effects, especially in adults. As a result, around 15-20% of patients do not complete the treatment.

“A shorter treatment that is just as effective and much safer than the current one would be a game-changer for people with Chagas disease,” says Quim Gascón, director of the Chagas, Parasitic and Imported Diseases Programme at ISGlobal.

Two weeks instead of eight

In the BENDITA clinical trial, Gascón’s team and colleagues in Bolivia compared the efficacy of different durations and doses of benznidazole, alone or in combination with another drug, in clearing the parasite from the blood up to six months after treatment. The study was led by the Drugs for Neglected Diseases Initiative (DNDi) and funded by the Global Health Innovative Technology Fund (GHIT), and was performed in three centres of the Platform for the Comprehensive Care of Chagas Patients in Cochabamba, Bolivia. The results show that 300 mg of benznidazole given daily for two weeks was equally effective as the standard regimen (same dose, given for eight weeks), and caused significantly fewer side effects. The combined use of the other drug (fosravuconazole) had no effect.

Impact of shorter treatments

The research team says the results need to be confirmed with larger multicentre trials, but have important implications for improving access to treatment. “This study provides hope for people affected by this neglected disease, as a shorter treatment will remove side effect concerns and improve treatment adoption,” says Gascón.

The findings should also help to simplify the treatment of young girls and women of child-bearing age so that they do not transmit the parasite to their babies. In fact, congenital transmission of Chagas disease is a public health problem even in areas where the vector is not present, and eliminating it has become one of the global objectives for the next decade.

Torrico F, Gascón J, Barreira F, Blum B, Almeda 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, on behalf of the BENDITA study group. New regimens of benznidazole monotherapy and in combination with fosravuconazole for Chagas disease (BENDITA): a phase 2, double-blind, randomised trial. Lancet Infect Dis. 2021. https://doi.org/10.1016/S1473-3099(20)30844-6

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