TABLE I. Reviews of the effect of aetiological treatment in patients with chronic Chagas disease.
Number of patients | Stage of Chagas disease | Number and type of studies | Follow up | Outcomes | |
---|---|---|---|---|---|
Villar et al. (2002) | 756 | Chronic phase (asymptomatic) | Five small randomised trials | 1-4 years | None of the studies assessed clinically relevant hard outcomes, and two tested ineffective drugs (itraconazole and allopurinol) versus placebo, instead of benznidazole or nifurtimox. Overall, parasite-related outcomes were significantly (statistically) improved, including the seroconversion rate (OR 10.91, 95% CI 6.07-19.58), xenodiagnoses conversion rate (OR 5.37, 95% CI 3.34-8.64), and standardised mean reduction of antibody titres (OR 0.54, 95% CI 0.31-0.84). |
Reyes and Vallejo (2005) | 714a | Chronic phase (asymptomatic and symptomatic) | One small randomised trial, and six uncontrolled or non-randomised studies | 1-23 yearsa | Overall results were insufficient to draw any conclusions. |
Pérez-Molina et al. (2009) | 1924 | Chronic phase (asymptomatic and symptomatic) | Three randomised trials, and six observational studies | 1-24 yearsa | Available information comparing benznidazole versus placebo or no treatment showed that children treated with benznidazole had a better tolerance and better parasite-related responses than adults did. More importantly, overall patients treated with benznidazole had a significantly lower risk of clinical events than those treated with placebo (OR 0.29, 95% CI 0.16-0.53). |
Villar et al. (2014) | 4229 | Chronic phase (asymptomatic) | Six randomised trials, and seven observational studies | At least 4 years | Ten studies tested nifurtimox or benznidazole versus placebo and showed potentially important, but imprecise and inconsistent reductions in progression of chronic Chagas cardiomyopathy (four studies, 106 events, OR 0.74, 95% CI 0.32-1.73, I2 = 66%) and mortality (six studies, 99 events, OR 0.55, 95% CI 0.26-1.14, I2 = 48%). |
a: calculated from the original studies included in the reviews; OR = odds ratio.