02612nas a2200265   4500000000100000008004100001260003700042653002400079653005700103653001700160100002500177700001400202700001300216700002400229700002000253700001300273700002000286700001400306245010700320856009900427300001300526490000700539520178600546022001402332       2022                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aBenznidazole1 aCrespillo-Andújar C1 aComeche B1 aHamer DH1 aArevalo-Rodriguez I1 aAlvarez-Díaz N1 aZamora J1 aPerez-Molina JA1 aRostami A00aUse of benznidazole to treat chronic Chagas disease: An updated systematic review with a meta-analysis  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0010386&type=printable  ae00103860 v163 a<p>Background Approximately 6 million people worldwide are affected by Chagas disease, with many in the chronic phase of the disease (CCD). It is crucial to evaluate the effectiveness of benznidazole for CCD treatment.</p>

<p>Methods/Principal findings We updated a meta-analysis published in 2009 up to February 2021, including controlled trials (RCT) and prospective observational studies (OBS) that compared benznidazole vs placebo/no-treatment (P/nT). Main outcomes evaluated were clinical progression (CP) and seroreversion with subgroup analysis performed according to study design and participants’ age. Parasitological response and safety were also described. We identified 879 articles and selected nine for inclusion (corresponding to eight studies). After adding the nine articles from the previous meta-analysis, 17 studies were analyzed corresponding to 6640 patients. The odds ratio (OR) for seroreversion in children treated with benznidazole vs P/nT was 38.3 (95%CI: 10.7–137) and 34.9 (95%CI: 1.96–624.09) in RCT and OBS, respectively. In adults the OR for seroreversion in OBS was 17.1 (95%CI: 2.3–129.1). CP was only evaluated in adults, where benznidazole did not demonstrate a beneficial effect: OR 0.93 (95%CI: 0.8–1.1) and OR 0.49 (95%CI:0.2–1.2) for RCT and OBS, respectively. Most outcomes were deemed to have a low level of certainty, except for the beneficial effect in children and the low efficacy in adults (moderate certainty). Conclusions Benznidazole should be recommended for CCD in children, though this is only based on serological response and a moderate grade of evidence, while in adults benznidazole efficacy remains uncertain. More data on clinical efficacy of benznidazole in CCD is needed in both children and adults.</p>
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