Current Treatment of Chagas Disease
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Neglected Tropical Diseases (A Sanchez, Section Editor)
Current Treatment of Chagas Disease Diego-Abelardo Álvarez-Hernández, MBBS, MSHc1,2,* Zaira-Leticia Castro-Rico, MBBS, MHA2 Rodolfo García-Rodríguez-Arana, MBBS, MHA2 Alberto-Manuel González-Chávez, MBBS, SGS3,4 Mario-Andrés González-Chávez, MBBS, SGS3,4 Luis-Alberto Martínez-Juárez, MBBS, MPH, DrPHc1 Claudia Ferreira, MD, PhD5 Rosalino Vázquez-López, BVMS, MMMI, PhD2 Address 1 Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT, Bloomsbury, London, UK *,2 Faculty of Health Sciences, Anahuac University Mexico-North Campus, 52786, Huixquilucan, Mexico State, Mexico Email: [email protected] 3 Faculty of Health Sciences, Panamerican University, Insurgentes Mixcoac, 03920, Mexico City, Mexico 4 Department of General Surgery, Spanish Hospital of Mexico, Granada, 11520, Mexico City, Mexico 5 Department of Medical Affairs, CF Medical Solutions, 92430, Marnes la Coquette, France
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collections on Neglected Tropical Diseases Keywords Neglected diseases I Vector-borne diseases I Parasitic diseases I American trypanosomiasis I Chagas disease
Abstract Purpose of review Chagas disease (CD) is recognized as a neglected tropical disease. It is endemic of Latin America, but globalization has led to its spread worldwide. Even though its presence has been tracked at least 9000 years ago, treatment options remain scarce. The purpose of this review is to analyze the evidence for current and future options to combat the disease. Recent findings CD patients benefit from dietary and exercise recommendations. Benznidazole and nifurtimox continue to be the available treatment options. Besides them, several drugs have been developed, repurposed, and tested in clinical trials, mostly inhibitors of the ergosterol synthesis like albaconazole, itraconazole, posaconazole, ravuconazole/ fosravuconazole, voriconazole, and TAK-187; antiarrhythmics like amiodarone/dronedarone;
Neglected Tropical Diseases (A Sanchez, Section Editor) inhibitors of the purine synthesis like allopurinol; nitroimidazoles like fexinidazole; and minerals like selenium. Even though they have shown in vitro and in vivo activity against Trypanosoma cruzi, their effectiveness is inferior to the one from benznidazole. Chronic CD patients who develop the cardio-digestive forms of the disease may eventually need assistive devices and/or surgical procedures to improve their outcome. Summary Benznidazole and nifurtimox are the only trypanosomal drugs available to combat T. cruzi infection, and their effectiveness relies upon the stage of the disease at where the patients are. Their side effects frequently lead to patient’s non-compliance to treatment. Therefore, more effective drugs with a better safety profile are required. Up to date, controversial and promising results have been observed. Further compromise and research must be encouraged to tackle the challenges
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