Chagas disease: A wake-up call to accelerate the diagnosis, treatment and research

The international, multicenter, double-blind and placebo-controlled "Benznidazole Evaluation for Interrupting Trypanosomiasis" (BENEFIT) trial initiated more than 10 years ago in order to determine whether the estimated 1.2 million people now living with chronic Chagas heart disease could benefit from treatment with benznidazole. Although the answer may seems to be "no," according to an article published in PLOS Neglected Tropical Diseases by the Global Chagas Disease Coalition, what the study ultimately indicates is the clear need to initiate treatment at earlier stages of the disease.

The study did not show incremental benefits in cardiac outcome, underlining the need to revisit the current strategies for anti-parasitic chemotherapy in patients with chagasic heart disease. Furthermore, 17-18% of patients in both the treated and placebo arms died over a period of five years, meaning that roughly 200,000 people will die from Chagas cardiomyopathy in the next five years. This number is comparable to that of women in the US who will die from breast cancer in the same period. However, in contrast with breast cancer, there is little advocacy and support for research and development in Chagas disease.

Despite the negative results, the BENEFIT trial highlights research issues that need to be urgently addressed, such as the best dosing schedule for benznidazole, the development of reliable surrogate markers that can predict clinical outcomes, and the role of co-infections and non-communicable diseases when treating patients chronically infected with Trypansoma cruzi. It also presents new opportunities to evaluate new formulations and drugs that are currently in the pipeline.

"The newest information coming from the BENEFIT trial highlights the urgency to develop improved therapeutics for millions of people now living with Chagas disease" said Professor Peter Hotez, senior author of the article and Dean of the National School of Tropical Medicine at Baylor College of Medicine. "We urgently need to redouble our efforts to identify and treat young people who are still in the early stages of their illness, but ultimately we need to find better treatments and new cures," emphasizes the authors on the article.

Some numbers on Chagas Disease:

• 5.7-9.4 million people live with Chagas Disease
• Less than 1% has access to diagnosis and treatment
• More than 50% of infected persons live in Latin America's wealthiest countries (Argentina, Brazil and Mexico)
• Hundreds of thousands of infected people live in USA and Europe, where parasite transmission can occur through blood and organ transfusions,
• and from mother to child.