Direct evidence gap on fixed versus adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: Systematic review and individual patient data meta-analysis

by Ciapponi A, Barreira F, Perelli L, Bardach A, Gascón J, Molina I, Morillo C, Prado N, Riarte A, Torrico F, Villar JC, Reidel S, Gibbons L, Sosa-Estani S. Tropical Medicine & International Health 2023, 28(1):2-16. doi: 10.1111/tmi.13831

Summary: Benznidazole is registered for the treatment of Chagas disease caused by Trypanosoma cruzi in adjusted-dose schemes. However, for practical reasons, fixed dosing schemes are being used, regardless of body weight. The authors conducted a systematic review and individual participant data meta-analysis to compare the efficacy and safety of fixed and adjusted doses for T. cruzi-seropositive adults without cardiomyopathy. Five randomized controlled trials involving 1198 patients were included, none of which directly compared fixed with adjusted doses. The authors found that the safety and efficacy of fixed doses of benznidazole are probably noninferior to weight-adjusted doses, when comparing the type of dose with placebo. A fixed dose of benznidazole could simplify treatment for patients and providers and may improve adherence.

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