Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context
Summary: Background: Endemic in more than 20 countries, Chagas disease affects 6.3 million people worldwide, leading to 28,000 new infections and 7700 deaths each year. Previous meta-analyses on antiparasitic treatment need updates to encompass recent studies and to assess key clinically meaningful...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024005510 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832591777801961472 |
|---|---|
| author | Anis Rassi, Jr Alyssa Grimshaw Ashwin Sarwal Ranjit Sah Sangam Shah Nelson I. Agudelo Higuita Fabio Mahamed Rassi Michaele Francesco Corbisiero Hannah M. Kyllo Jordan Stellern Samantha Kaplan Luis A. Marcos Edgar A. Ramírez-García Martin Casapia Peter Hotez Maria Elena Bottazzi Shital Patel Carlos Franco-Paredes José Antonio Marin-Neto Andrés F. Henao-Martínez |
| author_facet | Anis Rassi, Jr Alyssa Grimshaw Ashwin Sarwal Ranjit Sah Sangam Shah Nelson I. Agudelo Higuita Fabio Mahamed Rassi Michaele Francesco Corbisiero Hannah M. Kyllo Jordan Stellern Samantha Kaplan Luis A. Marcos Edgar A. Ramírez-García Martin Casapia Peter Hotez Maria Elena Bottazzi Shital Patel Carlos Franco-Paredes José Antonio Marin-Neto Andrés F. Henao-Martínez |
| author_sort | Anis Rassi, Jr |
| collection | DOAJ |
| description | Summary: Background: Endemic in more than 20 countries, Chagas disease affects 6.3 million people worldwide, leading to 28,000 new infections and 7700 deaths each year. Previous meta-analyses on antiparasitic treatment need updates to encompass recent studies and to assess key clinically meaningful endpoints. This study aims to evaluate the impact of antitrypanosomal therapy in preventing or reducing disease progression and mortality in chronic Chagas disease. Methods: We performed a systematic review and meta-analysis of studies reporting the cardiovascular outcomes of antitrypanosomal therapy in patients with chronic Chagas disease. We searched Ovid Embase, Ovid MEDLINE, Ovid Global Health, Scopus, Web of Science Core Collection, Cochrane Library, PubMed, Google Scholar, and Virtual Health Library databases from inception to May 18, 2024. We included aggregated data from randomized controlled studies and observational reports (full articles and abstracts) featuring antiparasitic interventions with benznidazole or nifurtimox compared to a control group. Primary outcomes were electrocardiogram (ECG) changes, disease progression, cardiovascular death, and overall mortality. A customized risk of bias scale assessed the methodological quality of studies, and a random-effects model estimated the pooled risk ratios. This investigation was registered in PROSPERO (CRD42023495755). Findings: Out of 4666 reports screened, 23 met the pre-specified inclusion criteria (8972 participants). Compared to no treatment or placebo, antiparasitic treatment led to a reduction in i) ECG changes (17 studies, 4994 participants: risk ratio (RR): 0.48, 95% CI 0.36–0.66, p < 0.001; I2 = 76.4%) with a number needed to treat (NNT) of 5; ii) disease progression (12 studies, 5722 participants: RR: 0.35, 95% CI 0.23–0.51, p < 0.001; I2 = 72.4%) NNT of 6; iii) cardiovascular death (7 studies, 5662 participants: RR: 0.44, 95% CI 0.21–0.95, p = 0.04; I2 = 50.5%) NNT of 22; and iv) overall mortality (10 studies, 7694 participants: RR: 0.54, 95% CI 0.34–0.87, p < 0.001; I2 = 60%) NNT of 23. Interpretation: We found compelling evidence that antiparasitic treatment significantly reduces the risk of ECG changes, disease progression, cardiovascular death, and overall mortality in chronic Chagas disease. Although the quality of evidence ranges from low to intermediate, with considerable heterogeneity across studies, the potential benefits are substantial. These findings support the broader use of trypanocidal therapy in the management of Chagas disease, though further research remains necessary. Funding: This study had no funding source. |
| format | Article |
| id | doaj-art-7eb3c7fa6cb046c6ac461bf64bb1565f |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-7eb3c7fa6cb046c6ac461bf64bb1565f2025-01-22T05:43:12ZengElsevierEClinicalMedicine2589-53702025-01-0179102972Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in contextAnis Rassi, Jr0Alyssa Grimshaw1Ashwin Sarwal2Ranjit Sah3Sangam Shah4Nelson I. Agudelo Higuita5Fabio Mahamed Rassi6Michaele Francesco Corbisiero7Hannah M. Kyllo8Jordan Stellern9Samantha Kaplan10Luis A. Marcos11Edgar A. Ramírez-García12Martin Casapia13Peter Hotez14Maria Elena Bottazzi15Shital Patel16Carlos Franco-Paredes17José Antonio Marin-Neto18Andrés F. Henao-Martínez19Division of Cardiology, Anis Rassi Hospital, Goiânia, GO, Brazil; Corresponding author. Hospital do Coração Anis Rassi, Avenida Anis Rassi, 453, Setor Oeste, Goiânia, Goiás, CEP 74 110-020, Brazil.Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USADivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USADepartment of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, IndiaTribhuvan University Teaching Hospital, Kathmandu, 44600, NepalUniversity of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal, Tegucigalpa, HondurasInstituto Dante Pazzanese de Cardiologia, São Paulo, SP, BrazilDivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USADivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USADivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USADivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USADivision of Infectious Diseases, Departments of Medicine, Microbiology and Immunology, Stony Brook University, Stony Brook, NY, USAUniversidad Nacional de la Amazonia Peruana, Hospital Regional de Loreto, Asociacion Civil Selva Amazónica, PerúUniversidad Nacional de la Amazonia Peruana, Hospital Regional de Loreto, Asociacion Civil Selva Amazónica, PerúDepartments of Pediatrics and Molecular Virology & Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, USADepartments of Pediatrics and Molecular Virology & Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, USADepartments of Pediatrics and Molecular Virology & Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, USAHospital Infantil de México, Ciudad de México, Mexico; Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, PanamáUnidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BrazilDivision of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, CO, USA; Corresponding author. University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.Summary: Background: Endemic in more than 20 countries, Chagas disease affects 6.3 million people worldwide, leading to 28,000 new infections and 7700 deaths each year. Previous meta-analyses on antiparasitic treatment need updates to encompass recent studies and to assess key clinically meaningful endpoints. This study aims to evaluate the impact of antitrypanosomal therapy in preventing or reducing disease progression and mortality in chronic Chagas disease. Methods: We performed a systematic review and meta-analysis of studies reporting the cardiovascular outcomes of antitrypanosomal therapy in patients with chronic Chagas disease. We searched Ovid Embase, Ovid MEDLINE, Ovid Global Health, Scopus, Web of Science Core Collection, Cochrane Library, PubMed, Google Scholar, and Virtual Health Library databases from inception to May 18, 2024. We included aggregated data from randomized controlled studies and observational reports (full articles and abstracts) featuring antiparasitic interventions with benznidazole or nifurtimox compared to a control group. Primary outcomes were electrocardiogram (ECG) changes, disease progression, cardiovascular death, and overall mortality. A customized risk of bias scale assessed the methodological quality of studies, and a random-effects model estimated the pooled risk ratios. This investigation was registered in PROSPERO (CRD42023495755). Findings: Out of 4666 reports screened, 23 met the pre-specified inclusion criteria (8972 participants). Compared to no treatment or placebo, antiparasitic treatment led to a reduction in i) ECG changes (17 studies, 4994 participants: risk ratio (RR): 0.48, 95% CI 0.36–0.66, p < 0.001; I2 = 76.4%) with a number needed to treat (NNT) of 5; ii) disease progression (12 studies, 5722 participants: RR: 0.35, 95% CI 0.23–0.51, p < 0.001; I2 = 72.4%) NNT of 6; iii) cardiovascular death (7 studies, 5662 participants: RR: 0.44, 95% CI 0.21–0.95, p = 0.04; I2 = 50.5%) NNT of 22; and iv) overall mortality (10 studies, 7694 participants: RR: 0.54, 95% CI 0.34–0.87, p < 0.001; I2 = 60%) NNT of 23. Interpretation: We found compelling evidence that antiparasitic treatment significantly reduces the risk of ECG changes, disease progression, cardiovascular death, and overall mortality in chronic Chagas disease. Although the quality of evidence ranges from low to intermediate, with considerable heterogeneity across studies, the potential benefits are substantial. These findings support the broader use of trypanocidal therapy in the management of Chagas disease, though further research remains necessary. Funding: This study had no funding source.http://www.sciencedirect.com/science/article/pii/S2589537024005510Chagas diseaseChagas cardiomyopathyTrypanosoma cruziAntitrypanosomal therapyBenznidazoleNifurtimox |
| spellingShingle | Anis Rassi, Jr Alyssa Grimshaw Ashwin Sarwal Ranjit Sah Sangam Shah Nelson I. Agudelo Higuita Fabio Mahamed Rassi Michaele Francesco Corbisiero Hannah M. Kyllo Jordan Stellern Samantha Kaplan Luis A. Marcos Edgar A. Ramírez-García Martin Casapia Peter Hotez Maria Elena Bottazzi Shital Patel Carlos Franco-Paredes José Antonio Marin-Neto Andrés F. Henao-Martínez Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context EClinicalMedicine Chagas disease Chagas cardiomyopathy Trypanosoma cruzi Antitrypanosomal therapy Benznidazole Nifurtimox |
| title | Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context |
| title_full | Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context |
| title_fullStr | Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context |
| title_full_unstemmed | Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context |
| title_short | Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysisResearch in context |
| title_sort | impact of antiparasitic therapy on cardiovascular outcomes in chronic chagas disease a systematic review and meta analysisresearch in context |
| topic | Chagas disease Chagas cardiomyopathy Trypanosoma cruzi Antitrypanosomal therapy Benznidazole Nifurtimox |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005510 |
| work_keys_str_mv | AT anisrassijr impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT alyssagrimshaw impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT ashwinsarwal impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT ranjitsah impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT sangamshah impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT nelsoniagudelohiguita impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT fabiomahamedrassi impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT michaelefrancescocorbisiero impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT hannahmkyllo impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT jordanstellern impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT samanthakaplan impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT luisamarcos impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT edgararamirezgarcia impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT martincasapia impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT peterhotez impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT mariaelenabottazzi impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT shitalpatel impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT carlosfrancoparedes impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT joseantoniomarinneto impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext AT andresfhenaomartinez impactofantiparasitictherapyoncardiovascularoutcomesinchronicchagasdiseaseasystematicreviewandmetaanalysisresearchincontext |