Benznidazole monotherapy is superior to treatment with posaconazole alone or posaconazole combined with benznidazole for the elimination of Trypanosoma cruzi (T. cruzi) in asymptomatic Chagas carriers, according to the results of the STOP-CHAGAS Trial published Feb. 20 in the Journal of the American College of Cardiology.

Chagas disease is the result of infection with T. cruzi and carries a significant tropical disease burden in the Western hemisphere. It is estimated that between 5.7 and 9.4 million people are infected, 20 to 30 percent of whom will develop cardiomyopathy. Low tolerability of current therapy methods often compromise treatment.

Carlos A. Morillo, MD, FACC, et al., conducted a prospective, multicenter randomized placebo-controlled study, in which 120 subjects from Latin America and Spain were randomized into four groups receiving either posaconazole; benznidazole and placebo; benznidazole and posaconazole; or placebo alone. T. cruzi parasites were measured by real-time polymerase chain reaction (RT-PCR) at 30, 60, 90, 120, 150, 180 and 360 days.

Only 13.3 percent of those receiving just posaconazole achieved the primary outcome – persistent negative RT-PCR by day 180 – compared to 80 percent for benznidazole and posaconazole combination therapy and 86.7 percent for benznidazole monotherapy. Serious adverse events were observed in six of the benznidazole-treated patients.

The authors conclude that benznidazole monotherapy is superior to posaconazole monotherapy and achieved RT-PCR conversion of T. cruzi in all subjects on treatment by 30 days, which was sustained for at least 1 year. Permanent discontinuation of benznidazole monotherapy was frequent, and combination therapy did not provide any further advantages compared to benznidazole monotherapy.

Moving forward, the authors explain that “Exploring novel therapeutic approaches for the treatment of Chagas disease is a priority, given the high rates of adverse effects and therapy discontinuation rates with currently available therapies. Similarly, reducing the burden of disease and progression to cardiomyopathy is critical.”

In an editorial comment, Caryn Bern adds that, “Development of new regimens for chronic T. cruzi infection remains challenging … Let us hope that the next 5 years bring more optimism and less frustration to Chagas disease patients, and the physicians who care for them.”

Keywords: Cardiomyopathies, Chagas Disease, Latin America, Nitroimidazoles, Parasites, Prospective Studies, Real-Time Polymerase Chain Reaction, Reverse Transcriptase Polymerase Chain Reaction, Spain, Triazoles, Trypanosoma cruzi

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