Materiały źródłowe

• #1 Chagas disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chagas-disease/diagnosis-treatment/drc-20356218

  Treatment for Chagas disease is to kill the parasite and ease symptoms. […] During the acute phase of Chagas disease, the medicines benznidazole and nifurtimox (Lampit) may help. Both medicines are offered in the regions most affected by Chagas disease. In the United States, the medicines are approved for treatment of children younger than 18 with chronic infection. […] Once Chagas disease becomes chronic, medicines won’t cure the disease. But the medicines may be offered to help slow the disease and its most serious complications. […] Other treatment depends on the symptoms. […] Heart-related complications. Treatment may include medicines, a pacemaker or other devices to control heart rhythm. Surgery, or even a heart transplant, might be needed. […] Digestive complications. Treatment may include diet changes, medicines and corticosteroids. In severe cases, surgery might be needed.

• #2 Experimental and Clinical Treatment of Chagas Disease: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5817734/

  Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi that infects a broad range of triatomines and mammalian species, including man. […] Since the 1960s, the only drugs available for the clinical treatment of this infection have been benznidazole (BZ) and nifurtimox (NFX). Treatment with these trypanocidal drugs is recommended in both the acute and chronic phases of CD. […] Thus, more efficient and better-tolerated new drugs or pharmaceutical formulations containing BZ or NFX are urgently needed. […] Taken together, the literature emphasizes the urgent need for new therapies for acute and chronic CD. […] A drawback of the studies assessing the efficacy of BZ in the chronic phase of CD is the lack of a marker to define cure. […] Current recommendations rely on the switch of serology from positive to negative; however, this may take many years, precluding its use in clinical trials.

• #3 Experimental and Clinical Treatment of Chagas Disease: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5817734/

  CD treatment has been explored using two approaches: development of a preventive vaccine and identification of new effective drugs. Currently, no vaccines for CD are available or undergoing clinical tests. […] The present treatment of CD, used for 40 years, is based on the nitroheterocyclic compounds nifurtimox (NFX) and benznidazole (BZ), which have trypanocidal activity against all parasitic forms. […] Because of the side effects, which can interrupt the therapeutic protocol, and limited cure efficacy (acute phase, 50-80%; chronic phase, 8-20%), they are considered far from ideal. […] According to the World Health Organization (WHO), the ideal drug for CD treatment should have the following characteristics: parasitological cure during the acute and chronic phases, efficacy in one dose or a few doses, low cost, absence of side effects or teratogenic effects, and no induction of resistance. However, no drug meets all these requirements then new, more effective, and better-tolerated compounds are urgently needed.

• #4 FDA approves first U.S. treatment for Chagas disease | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-first-us-treatment-chagas-disease

  The U.S. Food and Drug Administration today granted accelerated approval to benznidazole for use in children ages 2 to 12 years old with Chagas disease. It is the first treatment approved in the United States for the treatment of Chagas disease. […] The safety and efficacy of benznidazole were established in two placebo-controlled clinical trials in pediatric patients 6 to 12 years old. […] Benznidazole was approved using the Accelerated Approval pathway. The Accelerated Approval pathway allows the FDA to approve drugs for serious conditions where there is unmet medical need and adequate and well-controlled trials establish that the drug has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients. Further study is required to verify and describe the anticipated clinical benefit of benznidazole. […] The FDA granted benznidazole priority review and orphan product designation. These designations were granted because Chagas disease is a rare disease, and until now, there were no approved drugs for Chagas disease in the United States.

• #5 Clinical Care of Chagas Disease | Chagas Disease | CDC

  https://www.cdc.gov/chagas/hcp/clinical-care/index.html

  Antiparasitic treatment is necessary for all acute or reactivated Chagas cases. […] Antiparasitic treatment is indicated for all cases of acute or reactivated Chagas disease and for chronic T. cruzi infection in children up to age 18. […] Treatment is strongly recommended for adults up to 50 years old with chronic infection who do not already have advanced cardiomyopathy. […] For adults older than 50 years with chronic T. cruzi infection, the decision to treat with antiparasitic drugs should be individualized, weighing the potential benefits and risks for the patient. […] The two drugs used to treat infection with T. cruzi are nifurtimox and benznidazole. […] Benznidazole is approved by FDA for use in children 2 12 years of age and is available from www.benznidazoletablets.com. […] Lampit (nifurtimox) is FDA approved for treatment of children from birth to younger than 18 years and is commercially available for pharmacies to purchase from several drug wholesalers.

• #6 Clinical Care of Chagas Disease | Chagas Disease | CDC

  https://www.cdc.gov/chagas/hcp/clinical-care/index.html

  Contraindications for treatment include severe hepatic and/or renal disease. […] As safety for infants exposed through breastfeeding has not been documented, withholding treatment while breastfeeding is also recommended. […] Benznidazole is FDA-approved for the treatment of Chagas disease (American trypanosomiasis) caused by Trypanosoma cruzi in pediatric patients 2 12 years of age. […] Lampit (nifurtimox) is FDA approved for treatment of Chagas disease (American trypanosomiasis) caused by Trypanosoma cruzi in pediatric patients from birth to younger than 18 years (weighing at least 2.5 kg).

• #7 Chagas disease: Antitrypanosomal drug therapy – UpToDate

  https://www.uptodate.com/contents/chagas-disease-antitrypanosomal-drug-therapy/print

  Chagas disease: Antitrypanosomal drug therapy […] The only drugs with proven efficacy against Chagas disease in human trials are benznidazole and nifurtimox. In general, benznidazole is better tolerated and so is favored by most experts as the first-line treatment for Chagas disease. […] Both benznidazole and nifurtimox are contraindicated in pregnancy, so effective contraception should be assured. […] Antitrypanosomal agents are contraindicated in patients with severe renal or hepatic dysfunction.

• #8 Trypanocidal treatment of Chagas disease | Enfermedades Infecciosas y Microbiología Clínica

  https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-trypanocidal-treatment-chagas-disease-S0213005X20301932

  Trypanocidal treatment of Chagas disease […] Treatment of T. cruzi infection still relies on drugs licensed over 50 years ago: nifurtimox (launched by Bayer in 1965) and benznidazole (launched by Roche in 1971). […] Only two drugs with proven efficacy against T. cruzi are available today: benznidazole and nifurtimox. […] Benznidazole is generally preferred due to its better tolerability and tissue penetration, as well as its possibly higher efficacy. […] Treatment during the acute phase of Chagas disease is always recommended, regardless of the mechanism of infection, as well as in reactivations in immunosuppressed patients. […] The efficacy of treatment seems to decrease as time passes since the incidence of primary infection and is very poor when visceral involvement is established.

• #9

  https://link.springer.com/article/10.1007/s40506-018-0170-z

  Benznidazole is often considered the first-line therapy because of its better tolerability, but both drugs produce significant side effects. […] Effectiveness is higher for both drugs if administered as soon as possible after infection. Reported cure rates are as high as 96% for congenitally infected infants, 76% for acute infections, 62% for chronically infected children, and 37% for chronically infected adults. […] Evidence in favor of treating congenital cases, acute cases, and children in the early chronic phase is well established. […] However, the BENEFIT trial, a multinational randomized study comparing benznidazole and placebo in patients who already had developed advanced CCM, did not find significantly different outcomes. […] Current treatment recommendations take into account the phase of the disease and age of the patient. Acute and congenital cases, reactivations, and children in the chronic indeterminate phase should be offered antiparasitic treatment with benznidazole. […] Even though a majority of patients in the indeterminate phase will remain asymptomatic, currently, there is no way to predict which patients will progress to the determinate form of the disease.

• #10 Chagas Disease – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/extraintestinal-protozoa/chagas-disease

  Treatment of acute-stage Chagas disease with antiparasitic drugs does the following: Rapidly reduces parasitemia. Shortens the clinical illness. Reduces risk of mortality. Decreases the likelihood of chronic disease. […] Antiparasitic treatment is indicated for all cases of acute, congenital, or reactivated Chagas disease and for chronic indeterminate infection in children up to age 18 years. The younger the patient and the earlier treatment is started, the more likely that treatment will result in parasitologic cure. […] The efficacy of treatment decreases as the duration of infection lengthens, and adverse effects are more likely in adults. Treatment is indicated for T. cruzi-infected children up to age 18 years. It is recommended for those 18 to 50 years unless they have evidence of advanced cardiac or gastrointestinal (GI) disease. For patients 50 years, treatment is individualized based on potential risks and benefits.

• #11 Chagas disease – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/chagas-disease

  Chagas disease can be treated with Benznidazole and also Nifurtimox. Both medicines are almost 100% effective in curing the disease if given soon after infection at the onset of the acute phase. […] Chagas disease may be etiologically treated in order to eliminate the infection T. cruzi with benznidazole or nifurtimox. If treatment was initiated during the acute phase, both drugs are effective in killing the parasite. Every infected child should be treated. […] Nevertheless, the efficacy of both drugs diminishes the longer a person has been infected, although all patients including chronic cases benefit from improved clinicopathologic changes if treated. Benznidazole and nifurtimox should not be taken by pregnant women. […] The potential benefits of medication in chronic cases preventing or delaying the development of Chagas disease should be weighed against the long duration of treatment (up to 2 months), possible adverse reactions (occurring in up to 40% of treated patients), age, comorbidities, and other important characteristics of each patient. […] The patients correctly diagnosed patients should receive further medical or surgical, pathophysiological or symptomatic, treatment, specific to each case.

• #12

  https://www.who.int/news-room/fact-sheets/detail/chagas-disease-(american-trypanosomiasis)

  Chagas disease is curable if antiparasitic treatment is initiated early, in the acute phase. […] Chagas disease can be treated with benznidazole or nifurtimox. Both medicines kill the parasite and are fully effective in curing the disease if given early, in the acute phase, including in case of congenital transmission. […] Treatment is also indicated for patients in whom infection has been reactivated (for example, due to immunosuppression), and during the early chronic phase, including for girls and women of childbearing age (before or after pregnancy) to prevent congenital transmission. […] Adults with infection, especially those with no symptoms, should be offered treatment because antiparasitic medicines can also prevent or curb disease progression. […] Benznidazole and nifurtimox should not be administered to pregnant women or people with kidney or liver failure. […] Additionally, life-lasting follow up and specific treatment for cardiac, digestive or neurological manifestations are usually required.

• #13 Chagas Disease (American Trypanosomiasis) Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/214581-treatment

  Nifurtimox gained FDA approval in 2020 for pediatric patients (birth to younger than 18 years who weigh at least 2.5 kg) for the treatment of T cruzi infection. Approval for nifurtimox was based on the number of treated patients who became IgG antibody negative or who showed an at least 20% decrease in optical density on 2 different IgG antibody tests against antigens of T cruzi. […] For the most part, both benznidazole and nifurtimox are limited in their capacity to effect parasitologic cure, especially in chronically infected patients. […] Consistent with WHO 2022 and current CDC recommendations, all patients with acute Chagas disease, including infants with congenital infection and persons with reactivation of chronic infections due to immunosuppression, should be treated with either benznidazole or nifurtimox.

• #13 Chagas Disease (American Trypanosomiasis) Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/214581-treatment

  The current evidence-based consensus concerning treatment of T cruzi infection is that chronically infected children and adolescents up to 18 years of age should be treated with either benznidazole or nifurtimox. […] In addition, there is broad agreement that all women of childbearing age should be given a full course of treatment. […] In contrast to the largely good news related to the utility of treating children, adolescents, and women of child bearing age, the probability of parasitologic cure with a full course of either drug in adults with long-standing T cruzi infection, including persons in the indeterminate phase and those with manifest chagasic symptoms, most of whom presumably were infected while quite young, actually may be less than 10%. […] Until recently, data from properly structured randomized clinical trials (RCTs) that assess the effect of specific treatment outcomes in chronically infected adults have been lacking.

• #14 For health professionals: Chagas disease (American trypanosomiasis) – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/chagas-disease-american-trypanosomiasis/health-professionals-chagas-disease-american-trypanosomiasis.html

  American trypanosomiasis can be treated with benznidazole and nifurtimox. Both medicines are almost 100% effective in curing the disease. But this is only if given soon after infection at the onset of the acute phase. […] Treatment is also indicated for: those in whom the infection has been reactivated (for example, due to immunosuppression), infants with congenital infection, patients during the early chronic phase. […] Infected adults should be offered antiparasitic treatment to prevent, curb or halt disease progression. This is especially the case for those who show no symptoms. […] The potential benefits of medication in preventing or delaying the development of American trypanosomiasis should be weighed against: the long duration of treatment (up to 2 months), possible adverse reactions (occurring in up to 40% of treated patients).

• #15 Chagas disease: Definition, locations, treatment, and prevention

  https://www.medicalnewstoday.com/articles/chagas-disease

  To treat Chagas disease, a doctor may prescribe one of two drugs: benznidazole or nifurtimox. […] Both medications are almost 100% effective at curing the disease, but only if a person takes them soon after they get the T. cruzi parasite. […] The effectiveness of these drugs declines the longer a person has the parasite infection before receiving treatment. […] Prompt treatment with benznidazole or nifurtimox can often completely cure Chagas disease. […] Certain drugs can usually cure Chagas disease, but only if a person receives the treatment in the earliest stages of the disease.

• #16 Efficacy and Safety of Chagas Disease Drug Therapy and Treatment Perspectives | IntechOpen

  https://www.intechopen.com/chapters/59725

  Chagas disease, also known as American trypanosomiasis, is a neglected disease caused by the protozoan parasite Trypanosoma cruzi. […] Although Chagas disease has been discovered more than 100 years ago, there are currently only two drugs used to control Chagas disease (CD), benznidazole and nifurtimox. […] Benznidazole has a similar efficacy profile to nifurtimox. […] Currently, the main treatment for CD is benznidazole and nifurtimox and both compounds are effective in the acute phase to reduce parasitemia and the persistence and the clinical severity of the disease. […] Benznidazole can achieve over 70% of cure in cases of congenital and acute phase, while nifurtimox reaches 80% efficacy. […] However, these compounds have limited efficacy in the chronic phase, with efficacy rates of only 610%.

• #17 Efficacy and Safety of Chagas Disease Drug Therapy and Treatment Perspectives | IntechOpen

  https://www.intechopen.com/chapters/59725

  Although the aforementioned therapy is over 40 years old, there are limitations in this first line of treatment for CD. […] The dosage of BNZ in the acute phase of the disease should be provided in two or three administrations daily, during the 60-day period. […] It is considered as the first choice treatment because it exhibits a better safety and efficacy profile when compared to nifurtimox. […] In the acute phase, if the treatment is initiated immediately following the confirmation of the presence of T. cruzi in the direct examination of the peripheral blood, the cure percentages are greater than 7080%, independent of the transmission route. […] The treatment is the conventional treatment, lasting 60 days, and depending on the clinical conditions of the patient, it may be increased to 90 days.

• #18

  https://www.who.int/health-topics/chagas-disease

  Chagas disease can be treated with two antiparasitic medicines: benznidazole and nifurtimox. Both medicines are nearly 100% effective in curing the disease if given soon after infection, including the cases of congenital transmission. The efficacy of both diminishes, however, the longer a person has been infected and the adverse reactions are more frequent at older age. […] Treatment is also indicated for those in whom the infection has been reactivated due to immunosuppression, and for patients during the early chronic phase. Infected adults, especially those with no symptoms, should be offered treatment because antiparasitic treatment can also prevent or curb disease progression and prevent congenital transmission in pregnant women. In other cases the potential benefits of medication in preventing or delaying the development of Chagas disease should be weighed against the duration of treatment (up to 2 months) and possible adverse reactions (occurring in up to 40% of treated adult patients).

• #19 Chagas Disease: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21876-chagas-disease

  Providers use antiparasitic medications to treat Chagas, including benznidazole and nifurtimox. These are most effective when used in the acute phase or early in the chronic phase. […] If you have complications of chronic Chagas, you might need additional treatments. These could include surgery, anticoagulants or antiarrhythmic medications. […] Benznidazole and nifurtimox can have unpleasant side effects that can keep people from taking them as long as they need to. These include: Loss of appetite, nausea and vomiting, headaches, dizziness, anxiety and depression, insomnia, muscle pain. […] If you treat Chagas early, you have a better chance of getting rid of the parasites before they can cause serious complications. You’ll need to take medications for a month or more. […] Antiparasitics may be less effective at curing chronic infections, but they might reduce your risk of severe complications. If you have a chronic infection, you and your provider will need to monitor your health closely to treat any complications as soon as possible. You may need to manage certain health issues for the rest of your life.

• #20 Chagas Disease: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/chagas-disease

  Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. […] For people living with HIV, a single course of treatment with benznidazole or nifurtimox should be offered to individuals with T. cruzi infection who have not been previously treated and who do not have advanced Chagas cardiomyopathy, with a discussion of potential risks and benefits and shared decision making. […] Therapy for Chagas disease with benznidazole or nifurtimox is effective in reducing parasitemia and preventing clinical manifestations or slowing progression in patients with acute and reactivated disease. […] Benznidazole (commercially available at http://www.benznidazoletablets.com/en) is approved by the FDA for use in children 2 to 12 years of age. […] The recommended regimen is 8 to 10 mg/kg/day in three divided doses with food for 60 days.

• #21 Experimental and Clinical Treatment of Chagas Disease: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5817734/

  In addition, we review the pharmacokinetics and biodistribution of BZ. […] The most frequent side effects are anorexia, weight loss, paresthesia, drowsiness or psychic excitability, and gastrointestinal symptoms such as nausea, vomiting, and occasional intestinal cramps. […] The major limitation of BZ is the low cure rate during the chronic phase. […] A recent retrospective study has shown that treatment with BZ prevents the occurrence of ECG alterations and decreases serological immunofluorescence titers in patients with chronic CD. […] The most important study in recent years was the BENEFIT project (Benznidazole Evaluation for Interrupting Trypanosomiasis), which was a multicenter, double-blind, placebo-controlled trial of trypanocidal treatment of BZ for patients with chronic Chagas heart disease.

• #22 Chagas Disease – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/extraintestinal-protozoa/chagas-disease

  Once signs of advanced cardiac or GI disease appear, antiparasitic drugs are not recommended. […] Supportive measures include treatment for heart failure, pacemakers for heart block, antiarrhythmic medications, cardiac transplantation, esophageal dilation, botulinum toxin injection into the lower esophageal sphincter, and GI tract surgery for megacolon. […] The only effective antiparasitic drugs are Benznidazole and Nifurtimox. […] Benznidazole is generally better tolerated, and the duration of treatment is shorter. Both benznidazole and nifurtimox have substantial toxicity, which increases with age. […] Common adverse effects of benznidazole include allergic dermatitis, anorexia, weight loss, peripheral neuropathy, and insomnia. […] Common adverse effects of nifurtimox are anorexia, nausea, vomiting, weight loss, polyneuropathy, headache, dizziness, and vertigo. […] It is recommended that these medications not be used in pregnant women or in breastfeeding mothers.

• #23 Center of Excellence for Chagas Disease | Sylmar CA | Chagas Treatment

  https://chagasus.org/treatment/

  On August 29th, 2017 the FDA approved Benznidazole to treat Chagas Disease in children ages 2 to 12 years old with Chagas disease. […] Treatment with benznidazole or nifurtimox can prevent or significantly delay the severe forms of cardiomyopathy that accompany the chronic phase of Chagas disease, and is recommended for adults up to age 50 with the indeterminate form of Chagas disease. […] Benznidazole is considered the first-line treatment because it generally produces fewer side effects than nifurtimox. […] Nifurtimox can also produce insomnia, peripheral neuropathy, and amnesia.

• #24 Chagas disease – Wikipedia

  https://en.wikipedia.org/wiki/Chagas_disease

  Benznidazole is usually considered the first-line treatment because it has milder adverse effects than nifurtimox, and its efficacy is better understood. Both benznidazole and nifurtimox have common side effects that can result in treatment being discontinued. The most common side effects of benznidazole are skin rash, digestive problems, decreased appetite, weakness, headache, and sleeping problems. These side effects can sometimes be treated with antihistamines or corticosteroids, and are generally reversed when treatment is stopped. However, benznidazole is discontinued in up to 29% of cases. Nifurtimox has more frequent side effects, affecting up to 97.5% of individuals taking the drug. The most common side effects are loss of appetite, weight loss, nausea and vomiting, and various neurological disorders including mood changes, insomnia, paresthesia and peripheral neuropathy. Treatment is discontinued in up to 75% of cases. Both drugs are contraindicated for use in pregnant women and people with liver or kidney failure. As of 2019, resistance to these drugs has been reported.

• #25

  https://www.who.int/health-topics/chagas-disease

  Benznidazole and nifurtimox should not be taken by pregnant women or by people with kidney or liver failure. Nifurtimox is also contraindicated for people with a background of neurological or psychiatric disorders. […] Additionally, specific treatment for cardiac, or digestive or neurological manifestations may be required.

• #26 Chagas Disease (American Trypanosomiasis) Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/214581-treatment

  As with diagnostic procedures, the medical treatment of cardiac and gastrointestinal signs and symptoms attributable to Chagas disease is similar to that instituted for similar problems caused by other etiologies. Such patients should be referred to appropriate subspecialists for evaluation and management.

• #27 Diagnosis and management of Chagas disease and cardiomyopathy | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2012.109

  Chagas cardiomyopathy is the most severe and life-threatening manifestation of human Chagas diseasea 'neglected’ tropical disease caused by the protozoan parasite Trypanosoma cruzi. […] Management of Chagas cardiomyopathy focuses on the treatment of the three main syndromes. The use of -blockers in patients with Chagas disease and heart failure is safe, well tolerated, and should be encouraged. […] Most specialists and international institutions now recommend specific antitrypanosomal treatment of patients with chronic Chagas disease, even in the absence of evidence obtained from randomized clinical trials. […] Etiological treatment with trypanocidal drugs for chronically infected adults aged 50 years is recommended by most specialists, although robust evidence of their efficacy obtained from randomized clinical trials remains lacking. […] Currently available trypanocidal drugs have substantial toxicity and require careful monitoring; safer and more-effective drugs to treat the infection are desirable. […] Studies and clinical trials focused on the management of patients with Chagas cardiomyopathy are required.

• #28 Efficacy and Safety of Chagas Disease Drug Therapy and Treatment Perspectives | IntechOpen

  https://www.intechopen.com/chapters/59725

  The treatment of CCC aims to reduce symptoms, delay the evolution of ventricular dysfunction, and prolong survival. […] The efficacy and tolerability of these drugs in patients with CCC is extrapolated from the results obtained for other etiologies. […] The combination of diuretics, angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, and adrenergic beta blockers is highlighted for treating cardiac and gastrointestinal manifestations attributed to this phase of the disease. […] The treatment of thromboembolism is performed based on the established recommendations, alternating according to the extension and compromised organ. […] The combination of the diamidine prodrug DB289 and BNZ orally decreased parasitemia by 99%, while alone they led to 70 and 90% for DB289 and BNZ, respectively. […] These studies indicate that combination of new compounds or compounds used for alternative conditions have the potential to be a successful approach.

• #29 Chagas disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/chagas-disease/

  Chagas disease patients are treated with the antitrypanosomal drugs benznidazole and nifurtimox. […] Treatment against Chagas disease is most effective when initiated early (in the acute phase). […] First-line: benznidazole (generates free radicals that cause DNA damage in the parasite) […] Second-line: nifurtimox. […] Patients with severe cardiomyopathy: heart transplantation. […] High fiber diet with adequate fluid intake, laxatives, and/or rectal enemas to treat constipation. […] Patients with persistent constipation, fecalomas, sigmoid volvulus: rectosigmoidectomy (with either retrocecal interpositioning or end-to-side low colorectal anastomosis).

• #30 Experimental and Clinical Treatment of Chagas Disease: A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5817734/

  Benznidazole encapsulation in liposomes, nanoparticles, and other microparticles. […] The ongoing BERENICE project, a European-sponsored and -funded project comprising eight public and private institutions in Spain, Portugal, France, Brazil, and Argentina aims to obtain a more effective, better-tolerated, and cheaper BZ formulation to cure CD using nanotechnology. […] Because no safe and fully effective drug is available for CD treatment, and few drugs are being evaluated in clinical trials, research to find new treatments for CD is urgently needed.

• #31 Researchers discover potential treatment for Chagas disease

  https://news.uga.edu/researchers-discover-potential-treatment-for-chagas-disease/

  Researchers from the University of Georgia have discovered a potential treatment for Chagas disease, marking the first medication with promise to successfully and safely target the parasitic infection in more than 50 years. […] Human clinical trials of the drug, an antiparasitic compound known as AN15368, will hopefully begin in the next few years. […] The new drug works by targeting the parasite that causes the disease, Trypanosoma cruzi, also known as T. cruzi. […] The go-to medications used to treat Chagas aren’t terrible, Tarleton said, but they’re not ideal. They can pack some serious side effects and they’re not reliably effective, but they’re currently the only treatment option. […] Patients also have to take the drugs for two months. And even the common but mild side effects like headache or nausea get old after a few weeks. As a result, about one in five people being treated for the disease stop taking their medications before they have a chance to cure the infection.

• #32 Researchers discover compound that could treat Chagas disease

  https://www.drugtargetreview.com/news/105030/researchers-discover-compound-that-could-treat-chagas-disease/

  Using screening techniques, researchers have identified the compound called AN15368 which works as an antiparasitic against Chagas disease. […] Researchers from the University of Georgia, US have discovered a potential treatment for Chagas disease, marking the first medication with promise to successfully and safely target the parasitic infection in more than 50 years. Human clinical trials of the drug, an antiparasitic compound known as AN15368, will hopefully begin in the next few years. […] The new drug works by targeting the parasite that causes the disease, Trypanosoma cruzi, also known as T. cruzi. […] The study found the new medication was 100 percent effective in curing mice and non-human primates that were naturally infected by the parasite at a research facility. […] Identifying the prodrug AN15368, the team revealed that this targets the messenger RNA processing pathway in T. cruzi.

• #33 Researchers discover compound that could treat Chagas disease

  https://www.drugtargetreview.com/news/105030/researchers-discover-compound-that-could-treat-chagas-disease/

  AN15368 was found to be active in vitro and in vivo against a range of genetically distinct T. cruzi lineages. […] We have got something that is as close to effective as it can be in what is as close to a human as it could be and there are not any side effects. That really de-risks it by a lot going into humans, Tarleton said. It does not make it fail-safe, but it moves it much further along.

• #34 Early assessment of antibodies decline in Chagas patients following treatment using a serological multiplex immunoassay | Nature Communications

  https://www.nature.com/articles/s41467-024-54910-x

  The MultiCruzi assay, a multiplex antibody serology test, has proven effective in confirming Chagas disease and predicting parasitological cure earlier than conventional tests in infants and children with acute or early chronic Chagas disease. […] We propose integrating MultiCruzi as a serological method endpoint in proof-of-concept clinical trials for Chagas disease. […] The nested linear mixed model shows the average decline in antibodies with time per treatment group, keeping the connection between the patient and the antigens. The model shows a significantly faster decline in antibodies in the treatment groups compared to the placebo group. […] In summary, the nested LMM with MultiCruzi data shows significant differences in slopes between treatment and placebo groups after just 6 months, and this is confirmed and sustained after 12 months in sharp contrast to traditional ELISA tests that do not show any such significant decrease.

• #35 Amaryllidaceae plants: a potential natural resource for the treatment of Chagas disease | Parasites & Vectors | Full Text

  https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-021-04837-9

  Chagas disease is a neglected zoonosis caused by the parasite Trypanosoma cruzi. It affects over six million people, mostly in Latin America. Drugs available to treat T. cruzi infection have associated toxicity and questionable efficacy at the chronic stage. Hence, the discovery of more effective and safer drugs is an unmet medical need. […] There is no vaccine available, but there are two chemotherapeutic treatments for T. cruzi infection: benznidazole (BNZ) and nifurtimox (NFX). Both have good efficacy when administered early after infection and are well tolerated by infants. However, at the chronic stage, which is when a diagnosis is usually obtained, their efficacy diminishes, and the appearance of toxic side effects is common. […] Thus, safer and more efficacious drugs for the treatment of Chagas disease are needed.

• #36 Amaryllidaceae plants: a potential natural resource for the treatment of Chagas disease | Parasites & Vectors | Full Text

  https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-021-04837-9

  In an attempt to find potential therapies for Chagas disease, the search for new compounds extracted from plants has intensified in the past decade. […] Recently, members of the family Amaryllidaceae have attracted considerable attention due to their alkaloid composition, with unique structural features and multiple types of biological activity. […] Thinking of their anti-parasitic use, some Amaryllidaceae alkaloids have shown promising results against Plasmodium falciparum, Leishmania donovani, Trypanosoma brucei and T. cruzi. […] Now, with the aim to identify novel drug development starting points from natural products, we have screened a collection of 79 extracts from Amaryllidaceae plants for their anti-T. cruzi activity. […] The results retrieved in this study encourage further exploration of the chemical content of these extracts in search of new anti-T. cruzi drug development starting points.

• #37 Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008398

  Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole […] Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease, but less than 1% are estimated to have received antiparasitic treatment. Benznidazole was approved by the US Food and Drug Administration (FDA) for treatment of T. cruzi infection in 2017 and commercialized in May 2018. This paper analyzes factors that affect access to benznidazole following commercialization and suggests directions for future actions to expand access. […] We found that the mean number of persons who obtained benznidazole increased from just under 5 when distributed by the CDC to 13 per month after the commercial launch (from May 2018 to February 2019). Nine key barriers to access were identified: lack of multi-sector coordination, failure of health care providers to use a specific order form, lack of an emergency delivery system, high medical costs for uninsured patients, narrow indications for use of benznidazole, lack of treatment guidelines, limited number of qualified treaters, difficulties for patients to make medical appointments, and inadequate evaluation by providers to determine eligibility for treatment. Our analysis shows that access to benznidazole is still limited after FDA approval. […] We suggest six areas for strategic action for the pharmaceutical company that markets benznidazole and its allied private foundation to expand access to benznidazole in the US. In addition, we recommend expanding the existing researcher-clinician network by including government agencies, companies and others.

• #38 Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008398

  Less than 1% of persons in the United States with Trypanosoma cruzi infection, the cause of Chagas disease, have received antiparasitic treatment. […] We found that the average number of patients who received benznidazole from the manufacturer increased after commercialization from just under 5 (when distributed by the CDC) to 13 patients (when sold in commercial channels) per month. […] We identified various barriers to access to treatment such as problems in the drug ordering process, low demand from health care providers, inadequate clinical assessment of patient eligibility for treatment, obstacles for patients to make medical appointments or to pay medical costs, and weak coordination among key actors in the health system. […] In the US, benznidazole had been available since 2011 under investigational protocols from the Center of Disease Control and Prevention (CDC). However, a study in 2015 showed that less than 1% of those estimated to be infected in the US had been identified and few had received treatment. […] A milestone was reached on August 29, 2017, when the FDA approved benznidazole for use in children aged 2 to 12 years old; in addition the drug can be prescribed legally to patients of other ages, a common practice called off-label use. […] Following FDA approval, on May 14, 2018, CDC discontinued its benznidazole program, and Exeltis USA began to market Insud Pharma’s Benznidazole Tablets. Benznidazole became available through commercial channels, which was expected to make obtaining benznidazole less complex for physicians and to expand access to the medicine for infected individuals.

• #39 Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008398

  This paper therefore examines factors influencing access to benznidazole in the post-license period of commercialization and proposes actions that the manufacturer and others can take to expand access to benznidazole for infected individuals in the United States. […] Our analysis shows that many challenges remain in efforts to expand access to benznidazole in the US. We suggest six areas of strategic action to expand access to benznidazole, with a focus on the roles of Exeltis USA and FMS.

• #40 SciELO Brazil – Chagas disease: review of needs, neglect, and obstacles to treatment access in Latin America Chagas disease: review of needs, neglect, and obstacles to treatment access in Latin America

  https://www.scielo.br/j/rsbmt/a/vDX3W5Vgcw6FDJGRzWVXY3Q/

  Chagas disease is still extremely prevalent in 21 Latin American countries. […] Little progress has been made regarding the access to diagnosis and treatment at the primary health care level, calling into question the current policies to ensure the right to health and access to essential medications. […] The findings are based on an investigation requested by Médecins Sans Frontières Brazil through a consultancy in 2015, aiming to estimate the current costs of benznidazole production. […] Presently, the governments absence or inefficiency in responding to CD involves various elements ranging from medical supply and training, to proper access to diagnosis and treatment. […] In 2015, it was estimated that more than 80% of the people in the world affected by CD did not have access to diagnosis and specific treatment.

• #41 SciELO Brazil – Chagas disease: review of needs, neglect, and obstacles to treatment access in Latin America Chagas disease: review of needs, neglect, and obstacles to treatment access in Latin America

  https://www.scielo.br/j/rsbmt/a/vDX3W5Vgcw6FDJGRzWVXY3Q/

  Although treatment is not indicated for all cases, most of those chronically infected or presenting with a chronic indeterminate form of CD should receive specific treatment in accordance with the indications detailed in the 2016 Brazilian consensus on CD. […] The WHO has established four fundamental pillars that must be observed and implemented for CD so that access to medication is ensured in adequate quantity, quality, location, and timing. […] Unfortunately, CD programs in Latin America do not satisfactorily meet any of the pillars established by the WHO. […] Benznidazole and nifurtimox, the first- and second-line treatment for CD, respectively, were made available in the market in the 70s, and to date, are the only two drugs available for the treatment of CD in the world. […] The full course of CD treatment for an adult with an average weight of 70kg requires approximately 180, 100 mg pills.

• #42 Chagas disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chagas-disease/symptoms-causes/syc-20356212

  During the first phase of infection, treatment of Chagas disease aims to kill the parasite. […] Later, it’s no longer possible to kill the parasite. Treatment in this later phase is about managing symptoms. […] If you live in a high-risk area for Chagas disease, these steps can help prevent infection: Don’t sleep in a mud, thatch or adobe house. […] Use netting soaked with bug killer, called insecticide, over the bed with sides tucked in. […] Use bug killers to remove insects from a home. […] Use insect repellent on exposed skin.

• #43 Chagas disease: symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/chagas-disease?language=fr

  Aside from vector control through insecticides, there are no means of controlling Chagas disease, no effective treatment for chronic forms, and no vaccine. […] The DNDi (Drugs for Neglected Diseases initiative) set up in 2003 to tackle neglected diseases such as Chagas disease includes the Institut Pasteur, the Indian Council of Medical Research (India), the Oswaldo Cruz Foundation (Brazil), the Kenya Medical Research Institute, Mdecins Sans Frontires, and the Malaysian Ministry of Health. […] Blood screening is essential to prevent infection by blood transfusions and organ transplants.

• #44 Chagas Disease | What We Do | World Heart Federation

  https://world-heart-federation.org/what-we-do/chagas-disease/

  Treatment is urgently indicated for anyone during the acute phase and for those in whom the infection has been reactivated. In these situations, treatment is almost 100% effective, and the disease can be completely cured. […] During the acute phase, Chagas disease can be treated with two antiparasitic medicines: benznidazole and nifurtimox. Both medicines are nearly 100% effective in curing the disease if given soon after infection, including the cases of congenital transmission. The efficacy of both diminishes, however, the longer a person has been infected, and the risk of adverse reactions increases with age. […] Once Chagas disease reaches the chronic phase, medications won’t cure the disease, but they may help slow the progression of the disease and its most serious complications. Adults, especially those with the indeterminate form of the disease, should be offered treatment, but its potential benefits in preventing or delaying the development of Chagas disease should be weighed against the long duration and frequent adverse events. […] During the late chronic phase, when cardiac or digestive manifestations may occur, additional lifelong medical treatment and surgery are usually indicated.

• #45 Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3910900/

  Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. […] The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. […] Etiological treatment should now be mandatory for all adult chronic Chagas disease patients. […] Scientific evidence regarding the role of the parasite, Trypanosoma cruzi, as a stimulus and trigger for tissue damage has accumulated over the last 2 decades, providing a solid basis to reconsider antiparasitic treatment for chronic adult patients.

• #46 Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3910900/

  Numerous studies in animal models and humans have reported the efficacy of parasitic treatment in both the acute and chronic phase of CD, with two randomized studies having demonstrated the efficacy of benznidazole treatment in children. […] An association between clinical evolution and negative seroconversion has also been analyzed in these previous studies, as in a recent publication that reported 107 chronic adult patients with cure criteria. […] Antiparasitic treatment efficacy in Chagas disease can only be measured currently using anti-T. cruzi antibody titers and/or by parasite detection in blood. […] A long-term follow-up study using qualitative PCR before and after treatment with benznidazole demonstrated two key findings. […] Following benznidazole treatment, there is a reduction of several markers, such as anti-T cruzi gamma interferon (IFN-)-producing cells, T. cruzi antigen-specific antibody titers detected using nonconventional serology, and seroreactivity against specific recombinant antigens. […] The development of more-effective and safe drugs is a clear target for improved patient outcome and for clinical management. […] The evidence-based paradigm shift that supports etiological treatment of chronic patients will require the development of novel marker tools.

• #47 SciELO Brazil – An overview of Chagas disease treatment An overview of Chagas disease treatment

  https://www.scielo.br/j/mioc/a/QMWCXKgQ9D7jLnrmfCrYPwp/?lang=en

  Treatment of chronic infection can be successful at least in the sense that a proportion of those treated will seroconvert, even though detection of such seroconversion may take several years. […] Diagnosis and treatment of acute and chronic Chagas disease depends on several factors, of which the first must be generalized consensus of its importance at personal, scientific, and political levels. […] There seems a general agreement that the earlier a diagnosis can be made and treatment initiated then the better the prognosis for the patient. […] A comprehensive strategy is needed to improve and increase early diagnosis and provide early treatment. […] It is of immediate concern to establish a consensus for diagnostic procedures and treatment of patients according to the stage of the disease (acute phase, chronic phase, complications).

• #48 SciELO Brazil – An overview of Chagas disease treatment An overview of Chagas disease treatment

  https://www.scielo.br/j/mioc/a/QMWCXKgQ9D7jLnrmfCrYPwp/?lang=en

  Following the proposed policy for control of neglected tropical diseases, WHO (2006) has proposed to continue emphasis on the elimination of domestic Triatominae, and to reinforce all aspects of disease management. […] Ensuring access to existing drugs for all patients. […] Ensuring the stability of production, affordability and distribution of the existing drugs. […] Promoting research and development for better diagnostic tools, safer drugs, and improved formulations. […] Building a consensus about diagnostic procedures for blood banks and for congenital cases.

Zobacz więcej