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Arq. Bras. Cardiol. vol.98 no.4 São Paulo Apr. 2012
LETTER TO THE EDITOR
Adrian Bolívar-MejíaI; Alfonso J. Rodriguez-MoralesII
IFacultad de Salud - Universidad Industrial de Santander1, Bucaramanga, Colombia
IIGrupo Infección e Inmunidad - Facultad de Ciencias de la Salud - Universidad Tecnológica de Pereira y Oficina de Investigación Científica - Cooperativa de Entidades de Salud de Risaralda (COODESURIS), Pereira, Risaralda, Colombia
Keywords: Chagas disease/epidemiology; Chagas disease/therapy.
We read with interest the guidelines published by Andrade et al. on the diagnosis and treatment of Chagas Disease1. We enjoy that initiative due to the need to develop guidelines that allow an adequate approach to this zoonosis, which still continues affecting millions of people throughout Latin America2.
However, based on the recent progress on the pathophysiology of Chagas disease and the biology of Trypanosoma cruzi, we would like to point out, that several drugs that have been proposed as alternatives for its etiological management. This phenomenon has emerged as the product of evidence that suggest the presence of this parasite in the chronic phase, which justifies the use of anti-Chagas disease drugs not only in the acute phase. Thus, various groups of drugs (for example, sterol biosynthesis inhibitors, inhibitors of cysteine proteases, pyrophosphate metabolism inhibitors, inhibitors of purines, trypanothione metabolism inhibitors) have been studied. Some of them proved to be potentially future therapeutic tools, given the evidence that supports their trypanocidal activity both in vitro and in vivo. In addition to that, there is a huge advantage of having shown few side effects compared to currently used anti-Chagas disease drugs and, in many cases, better pharmacokinetic and pharmacodynamic properties2,3.
Therefore, regarding the need for new effective, safe and easily accessible drugs for the etiological handling of the Chagas disease, there is a myriad of possibilities which, in the light of current evidence, promises new therapies against this public health problem. It would have been interesting that those potentialities were commented, including evidence that such new drugs has appeared so far, especially because it has been published and there are ongoing studies in different Latin American countries employing these drugs in the etiological treatment of Chagas Disease2.
1. Andrade JA, Marin-Neto JA, Paola AA, Vilas-Boas F, Oliveira GM, Bacal F, et al. [I Latin American guidelines for the diagnosis and treatment of Chagas cardiomyopathy]. Arq Bras Cardiol. 2011;97(2 Suppl. 3):1-48.
2. Rodríguez-Morales AJ. Nuevas perspectivas en el manejo terapéutico de la enfermedad de Chagas. Rev Peru Med Exp Salud Pública. 2005;22(2):123-33.
3. Hidron A, Vogenthaler N, Santos-Preciado JI, Rodriguez-Morales AJ, Franco-Paredes C, Rassi A Jr. Cardiac involvement with parasitic infections. Clin Microbiol Rev. 2010;23(2):324-49.
The World Health Organization and the Pan American Health Organization recommended the etiological treatment in countries with high prevalence of Chagas disease. A public health policy in some South American countries prescribe the treatment of patients with the indeterminate form of the disease in its chronic phase, especially for children and young patients. Treatment in the late chronic phase aims to reduce parasitemia, prevent progression of visceral lesions and interrupt the chain of transmission.
The results of observational studies and randomized studies in children suggest benefit in preventing the emergence of Chagas heart disease, although there are no randomized studies that demonstrate reduction of outcomes in adult patients with the indeterminate or chronic form of the disease. In addition to these clinical data, other arguments in favor of the treatment consist of experimental evidence that demonstrated a reduction in the progression of Chagas heart disease, the same occurring with observational studies in humans, and the occurrence of minor side effects only.
Thank you for emphasizing the need to describe the etiological treatment, although the therapeutic alternatives available for clinical use are still quite unsatisfactory. We recognize the potential of the drugs suggested by the correspondents and await the results of the BENEFIT study, a multicenter, randomized, double-blind, controlled study that will evaluate, for six years, more than 2,850 patients with chronic Chagas disease treated with benznidazole or placebo for about two months.
Jadelson Pinheiro de Andrade
José Antônio Marin-Neto
Gláucia Maria Moraes de Oliveira
Alfonso J. Rodriguez-Morales
Bosques de Santa Helena I, Apto 206 - Av. Sur (Las Americas 54-10), Zona Postal 1
660001 - Pereira - Risaralda - Colombia
Manuscript received November 15, 2011; revised manuscript received November 15, 2011; accepted February 23, 2012.
1. Andrade JA, Marin-Neto JA, Paola AA, Vilas-Boas F, Oliveira GM, Bacal F, et al. [I Latin American guidelines for the diagnosis and treatment of Chagas cardiomyopathy]. Arq Bras Cardiol. 2011;97(2 Suppl. 3):1-48. [ Links ]
2. Rodríguez-Morales AJ. Nuevas perspectivas en el manejo terapéutico de la enfermedad de Chagas. Rev Peru Med Exp Salud Pública. 2005;22(2):123-33. [ Links ]
3. Hidron A, Vogenthaler N, Santos-Preciado JI, Rodriguez-Morales AJ, Franco-Paredes C, Rassi A Jr. Cardiac involvement with parasitic infections. Clin Microbiol Rev. 2010;23(2):324-49. [ Links ]