Key result
Benznidazole or nifurtimox treatment in chronic chagasic patients yielded a 5.9% rate of unfavourable clinical evolution compared to 13% in untreated patients (not statistically significant).
Why the study?
Does treatment with benznidazole or nifurtimox prevent the development or progression of chagasic cardiomyopathy in patients with chronic Chagas disease?
Cohort (n=198)
No
Does treatment with benznidazole or nifurtimox prevent the development or progression of chagasic cardiomyopathy in patients with chronic Chagas disease?
Absolute Event Rate: 5.9% vs 13%
Treatment with benznidazole or nifurtimox in chronic Chagas disease may be associated with a better clinical evolution and lower antibody levels, though differences in overall unfavourable clinical evolution were not statistically significant.
May support slower progression in chronic Chagas; leaves open confirmation by randomized trials before changing practice.
The aim of this work was to compare the evolution of chronic chagasic untreated patients (UTPs) with that of benznidazole or nifurtimox-treated patients (TPs). A longitudinal study from a low endemic area (Santa Fe city, Argentina) was performed during an average period of 14 years. Serological and parasitological analyses with clinical exams, ECG and X-chest ray were carried out. At the onset, 19/198 infected patients showed chagasic cardiomyopathy (CrChM) while 179 were asymptomatic. In this latter group the frequency of CrChM during the follow-up was lower in TPs compared with UTPs (3.2% vs 7%). Within the CrChM group, 2/5 TPs showed aggravated myopathy whereas this happened in 9/14 UTPs. Comparing the clinical evolution of all patients, 5.9% of TPs and 13% of UTPs had unfavourable evolution, but the difference is not statistically relevant. Serological titers were assessed by IIF. Titers equal to or lower than 1/64 were obtained in 86% of the TPs, but only in 38% of UTPs. The differences were statistically significant (geometric mean: 49.36 vs. 98.2). Antiparasitic assessment of the drugs (xenodiagnosis) proved to be effective. The low sensitivity in chronic chagasic patients must be born in mind. Despite treated patients showed a better clinical evolution and lower antibody levels than untreated ones, it is necessary to carry on doing research in order to improve therapeutic guidelines, according to the risk/benefit equation and based on scientific and ethical principles.
No takes yet. Share an insight, caveat, or question.
SUASNÁBAR et al. (2000) conducted a cohort in Chronic Chagas disease (n=198). Benznidazole or nifurtimox vs. Untreated was evaluated on Unfavourable clinical evolution. Benznidazole or nifurtimox treatment in chronic chagasic patients yielded a 5.9% rate of unfavourable clinical evolution compared to 13% in untreated patients (not statistically significant).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: