Benznidazole did not reduce progression of Chagas disease cardiomyopathy (CCM) among patients, according to a trial presented at a Hot Line session yesterday and published simultaneously in the New England Journal of Medicine. However, the BENznidazole Evaluation For Interrupting Trypanosomiasis (BENEFIT) study did find that a 40-80 day treatment with this antiparasitic medication significantly reduced parasitic activity in the blood.
The BENEFIT study was the largest to date to examine the impact of benznidazole in cardiomyopathy patients with Chagas disease (CD), which affects around 7 million people worldwide, including more than 100,000 in Europe.
Presenter Carlos Morillo from McMaster University, Ontario, Canada, said the findings ‘may seem disappointing’ but have the potential to ‘dramatically change the way we investigate’ this potentially life-threatening condition
Recent data has indicated that parasite persistence may play a role in the pathogenesis of chronic CCM. However, the role of trypanocidal therapy in CCM is unknown. Thus the BENEFIT trial set out to evaluate whether the use of this approach with benznidazole reduced mortality and progression in CCM.
A total of 2854 patients at 49 sites in five countries were randomised between 2004 to 2011 to either benznidazole for 40 to 80 days. After an average follow-up of 5.4 years, the primary outcome was met in 27.5% of the benznidazole group and in 29.1% of the placebo group. Blood parasite detection by PCR was 66.2% for the treatment arm and 33.5% for placebo although this diminished after five years.
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