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Posaconazole therapy results in higher treatment failure for Chagas’ disease

Although posaconazole therapy demonstrated antitrypanosomal activity in the treatment of Chagas’ disease, patients experienced more treatment failure during follow-up than when traditional benznidazole therapy was used.

In a prospective, open-label trial, researchers randomly assigned 78 patients to receive 150 mg oral benznidazole twice daily, 100 mg oral posaconazole twice daily or 400 mg oral posaconazole twice daily for 60 days. Eligible patients were at least 18 years old and were detected to have Trypanosoma cruzi infection on two different serologic tests.

Follow-up visits occurred at 7, 14, 28, 45, and 60 days after treatment initiation; patients were then followed for 40 weeks after the treatment period ended.

During the treatment period, all patients tested negative for T. cruzi after day 14. However, during the follow-up period, 92% of patients in the low-dose posaconazole group and 81% in the high-dose posaconazole group tested positive for T. cruzi DNA on rt-PCR, compared with 38% in the benznidazole group, according to the researchers. A protocol analysis showed 90% of patients in the low-dose and 80% of patients in the high-dose posaconazole groups tested positive on rt-PCR, compared with only 6% in the benznidazole group.

Treatment was discontinued in five patients from the benznidazole group as a result of severe cutaneous reactions; although four patients in the posaconazole groups exhibited aminotransferase levels more than three times the upper limit of normal, no discontinuations of treatment occurred.

Disclosure: The authors have no relevant financial disclosures.