Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 24, Issue 12, Pages -Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2018.06.006
Keywords
Adverse drug reaction; Benznidazole; Chagas disease; Drug toxicity; Nifurtimox
Categories
Funding
- ISCIII (Instituto de Salud Carlos III),' Red de Enfermedades Tropicales, Subprograma RETICS (Redes Tematicas de Investigacion Cooperativa en Salud) del Plan Estatal de I+D+I 2013-2016 [RD16/0027/0020, RD16/0027/0002]
- FEDER (Fondo Europeo de Desarrollo Regional)
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Objective: To describe the tolerability and rate of nifurtimox discontinuation when administered as a second-line treatment to patients with previous treatment interruptions due to adverse reactions with benznidazole. Methods: We studied a prospective cohort study of adult patients with chronic Chagas disease in a referral centre in Spain treated from July 2007 to July 2017. We analysed the tolerability profile and treatment interruption rate due to adverse reactions (ARs) to nifurtimox in patients previously incompletely treated (less than 30 days) with benznidazole due to ARs. Results: A total of 472 patients initiated treatment with benznidazole during the study period. Of these, 118 (25%) developed ARs that led to treatment discontinuation before 30 days of therapy. Fifty-three (44.9%) of 118 initiated nifurtimox as second-line treatment; most were women (79.3%), were of Bolivian origin (98.1%) and had a median age of 37.3 years (interquartile range, 29.8e43.2). The most common ARs with nifurtimox were cutaneous hypersensitivity (24.1%), digestive disorders (22.2%), fever (12.9%), neurologic disturbances (11.1%), depression, anxiety or insomnia (9.2%), dyspnoea (7.4%), myalgia (5.5%), and dizziness, asthenia or malaise (7.4%). Twenty-six (49.1%) of 53 patients discontinued nifurtimox due to ARs, all of them before the required minimal therapy duration of 60 days. There were no deaths. Conclusions: Treatment of chronic Chagas disease relies on two drugs with a poor tolerability profile. In our cohort, 12.3% of the patients who initiated benznidazole and subsequently nifurtimox in case of nontolerance developed ARs that led to permanent treatment discontinuation. Most were women of childbearing age, a group for whom therapy has the added benefit of interrupting vertical transmission. C. Crespillo-Andujar, Clin Microbiol Infect 2018; 24: 1344.e1-1344.e4 (C) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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