Chagas disease
Conditions
Interventions
1. Benznidazole: 60 days of treatment at 5 mg/kg/day given twice a day (at maximum dose of 400 mg/day)
2. Matching placebo: 60 days of treatment at 5 mg/kg/day given twice a day (at maximum dose of 40
Sponsors
Hamilton Health Science Corporation (HHSC) (Canada)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Either sex, aged greater than or equal to 18 and less than or equal to 70 years 2. At least two positive serological tests for Chagas disease (indirect immunofluorescence, indirect hemagglutination, OR Enzyme-Linked Immunosorbent Assay [ELISA]) and at least ONE of the following markers of cardiac involvement (which identify individuals at high risk of progression): 2.1. Abnormal 12 lead Electrocardiogram (ECG): One-major criteria (second or third degree AV block) OR at least two minor criteria: 2.1.1. Any bundle branch block 2.1.2. Any fascicular block 2.1.3. Ventricular premature beats (greater than one) 2.1.4. First degree AV block greater than 220 ms, in the absence of drugs that slow AV node conduction 2.1.5. Mobitz type I AV block, in the absence of drugs that slow AV 2.1.6. Sinus bradycardia less than 50 bpm or sinus pauses greater than 3.0s, in the absence of sinus node blocking drugs 2.1.7. Low voltage of QRS in the frontal plane 2.1.8. Atrial fibrillation 2.2. Increased cardiothoracic ratio greater than 0.50 at baseline on upright chest X ray 2.3. Evidence of regional wall motion abnormality (hypokinesis, akinesis or dyskinesis) or reduced global Left Ventricular Systolic Function (LVEF) less than 50% (2D-Echo Radionuclide Angiography [RNA] LV ventriculography) or increased left ventricular diastolic diameter (greater than 55 mm) on 2D-Echo 2.4. Complex ventricular arrhythmias (multiform greater than 10/hour, couplets or non-sustained Ventricular Tachycardia [NSVT]) on 24 hour ambulatory ECG monitoring
Exclusion criteria
Exclusion criteria: 1. New York Heart Association (NYHA) heart failure class IV or decompensated heart failure 2. Evidence of concomitant Coronary Artery Disease (CAD) or other etiology of dilated cardiomyopathy 3. Previous treatment with antitrypanosomal agents or an accepted indication for antiparasitic therapy (e.g. reactivation of Chagas infection due to immunosuppression by several diseases or treatment with steroids) 4. Patients living in inadequate housing conditions that may predispose to t. cruzi re-infection will not be excluded; instead this condition will be appropriately documented 5. Inability to comply with follow-up 6. History of severe alcohol abuse within two years 7. Known chronic renal insufficiency (serum creatinine greater than 2.5 mg/dl or 200 umol) or hepatic insufficiency (Aspartate Aminotransferase [AST]/Alanine Aminotransferase [ALT] greater than 3 x normal) 8. Pregnancy or breast feeding 9. Megaesophagus with swallowing impairment 10. Other severe disease significantly curtailing life expectancy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| There are two related co-primary outcomes: 1. Negativisation and reduction of t. cruzi detected by PCR at the end of treatment which lasted 60 days, and at a two-year follow-up 2. Reduction in the mean burden of t. cruzi (parasite load) as detected by the concentration of t. cruzi/ml of blood by PCR in the treated group, at the end of treatment which lasted 60 days, and at a two-year follow-up | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Safety and tolerability of benznidazole in chronic Chagas cardiomyopathy, 11 ± 2 days after initial randomisation, three weeks ± 3 days after randomisation, end of therapy (60 days) and two years later 2. Long-term feasibility of conducting a Randomised Controlled Trial (RCT) in patients with Chagas disease measured by patient enrolment and completion of follow-up, recruitment rate measured at baseline, completion measured at the end of therapy (60 days later), and two years later 3. Cardiovascular events: 3.1. Composite of major cardiovascular outcomes defined as the first occurrence of: death, cardiac arrest, sustained ventricular tachycardia, symptomatic heart failure, pacemaker or implantable cardiac defibrillator insertion, ischemic stroke or other systemic thromboembolic event, 11 days, 21 days, 60 days, 6 months, 1 year and 2 year after randomisation 3.2. New development of any of the following echo changes: segmental wall motion abnormalities, ventricular aneurysm, reduction in LV ejection fraction greater than 5%, increase in Left Ventricular end-Diastolic Dimension [LVDD] greater than 5.0 mm compared with baseline, 11 days, 21 days, 60 days, 6 months, 1 year and 2 year after randomisation 3.3. New 12 lead ECG alterations (complete bundle branch block, fascicular block, advanced atrio-ventricular block, atrial fibrillation, etc); 1st Degree AV Block PR greater than 280 ms, 11 days, 21 days, 60 days, 6 months, 1 year and 2 year after randomisation 3.4. Progression of NYHA functional class by at least one category, 11 days, 21 days, 60 days, 6 months, 1 year and 2 year after randomisation | — |
Countries
Argentina, Brazil, Canada, Colombia
Outcome results
None listed