Posaconazole Found Lacking in Treatment of Chagas' Disease
Treatment with posaconazole led to more treatment failures versus benznidazole
THURSDAY, May 15, 2014 (HealthDay News) -- Compared to the standard of care (benznidazole), the new drug posaconazole is not effective for the treatment of Chagas' disease, according to a study published in the May 15 issue of the New England Journal of Medicine.
Israel Molina, M.D., from the Vall d'Hebron Teaching Hospital in Barcelona, Spain, and colleagues randomized 78 patients to receive posaconazole (400 mg twice daily; high-dose posaconazole), posaconazole (100 mg twice daily; low-dose posaconazole), or benznidazole (150 mg twice daily) for 60 days. Trypanosoma cruzi DNA (measured using realtime polymerasechainreaction [rtPCR] assays both during the treatment period and 10 months after the end of treatment) was assessed as a measure of antiparasitic activity.
The researchers found that all the patients tested negative for Trypanosoma cruzi DNA on rtPCR assay beyond day 14, except for two patients in the low-dose posaconazole group who tested positive on day 60. Ninety percent of the patients receiving low-dose posaconazole and 80 percent of those receiving high-dose posaconazole tested positive on rtPCR assay, compared to 6 percent receiving benznidazole (benznidazole group versus either posaconazole group, P < 0.001). Treatment was discontinued in five patients in the benznidazole group because of severe cutaneous reactions. Four patients in the posaconazole groups had aminotransferase levels that were more than three times the upper limit of the normal range.
"Posaconazole showed antitrypanosomal activity in patients with chronic Chagas' disease. However, significantly more patients in the posaconazole groups than in the benznidazole group had treatment failure during follow-up," the authors write.