TY - JOUR
T1 - Efficacy and safety of fexinidazole for treatment of chronic indeterminate Chagas disease (FEXI-12)
T2 - a multicentre, randomised, double-blind, phase 2 trial
AU - Pinazo, Maria Jesus
AU - Forsyth, Colin
AU - Losada, Irene
AU - Esteban, Elena Trigo
AU - García-Rodríguez, Magdalena
AU - Villegas, Maria Luz
AU - Molina, Israel
AU - Crespillo-Andújar, Clara
AU - Gállego, Montserrat
AU - Ballart, Cristina
AU - Ramirez, Juan Carlos
AU - Aden, Tilman
AU - Hoerauf, Achim
AU - Pfarr, Kenneth
AU - Vaillant, Michel
AU - Marques, Tayná
AU - Fernandes, Jayme
AU - Blum, Bethania
AU - Ribeiro, Isabela
AU - Sosa-Estani, Sergio
AU - Barreira, Fabiana
AU - Gascón, Joaquim
AU - FEXI-12 Study Team
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/4
Y1 - 2024/4
N2 - Background: More than six million people worldwide, particularly in vulnerable communities in Latin America, are infected with Trypanosoma cruzi, the causative agent of Chagas disease. Only a small portion have access to diagnosis and treatment. Both drugs used to treat this chronic, neglected infection, benznidazole and nifurtimox, were developed more than 50 years ago, and adverse drug reactions during treatment pose a major barrier, causing 20% of patients to discontinue therapy. Fexinidazole proved efficacious in an earlier, interrupted clinical trial, but the doses evaluated were not well tolerated. The present study evaluated fexinidazole at lower doses and for shorter treatment durations. Methods: In this randomised, double-blind, phase 2 trial, we included adult patients (18–60 years old) with confirmed T cruzi infection by serology and PCR and without signs of organ involvement. We evaluated three regimens of fexinidazole—600 mg once daily for 10 days (6·0 g total dose), 1200 mg daily for 3 days (3·6 g), and 600 mg daily for 3 days followed by 1200 mg daily for 4 days (6·6 g)—and compared them with a historical placebo control group (n=47). The primary endpoint was sustained negative results by PCR at end of treatment and on each visit up to four months of follow-up. This study is registered with ClinicalTrials.gov, NCT03587766, and EudraCT, 2016-004905-15. Findings: Between Oct 16, 2017, and Aug 7, 2018, we enrolled 45 patients (n=15 for each group), of whom 43 completed the study. Eight (19%) of 43 fexinidazole-treated patients reached the primary endpoint, compared with six (13%) of 46 in the historical control group. Mean parasite load decreased sharply following treatment but rebounded beginning 10 weeks after treatment. Five participants had seven grade 3 adverse events: carpal tunnel, sciatica, device infection, pneumonia, staphylococcal infection, and joint and device dislocation. Two participants discontinued treatment due to adverse events unrelated to fexinidazole. Interpretation: The fexinidazole regimens in this study had an acceptable safety profile but did not prove effective against T cruzi infection. Development of fexinidazole monotherapy for treating T cruzi infection has been stopped. Funding: The Drugs for Neglected Diseases initiative.
AB - Background: More than six million people worldwide, particularly in vulnerable communities in Latin America, are infected with Trypanosoma cruzi, the causative agent of Chagas disease. Only a small portion have access to diagnosis and treatment. Both drugs used to treat this chronic, neglected infection, benznidazole and nifurtimox, were developed more than 50 years ago, and adverse drug reactions during treatment pose a major barrier, causing 20% of patients to discontinue therapy. Fexinidazole proved efficacious in an earlier, interrupted clinical trial, but the doses evaluated were not well tolerated. The present study evaluated fexinidazole at lower doses and for shorter treatment durations. Methods: In this randomised, double-blind, phase 2 trial, we included adult patients (18–60 years old) with confirmed T cruzi infection by serology and PCR and without signs of organ involvement. We evaluated three regimens of fexinidazole—600 mg once daily for 10 days (6·0 g total dose), 1200 mg daily for 3 days (3·6 g), and 600 mg daily for 3 days followed by 1200 mg daily for 4 days (6·6 g)—and compared them with a historical placebo control group (n=47). The primary endpoint was sustained negative results by PCR at end of treatment and on each visit up to four months of follow-up. This study is registered with ClinicalTrials.gov, NCT03587766, and EudraCT, 2016-004905-15. Findings: Between Oct 16, 2017, and Aug 7, 2018, we enrolled 45 patients (n=15 for each group), of whom 43 completed the study. Eight (19%) of 43 fexinidazole-treated patients reached the primary endpoint, compared with six (13%) of 46 in the historical control group. Mean parasite load decreased sharply following treatment but rebounded beginning 10 weeks after treatment. Five participants had seven grade 3 adverse events: carpal tunnel, sciatica, device infection, pneumonia, staphylococcal infection, and joint and device dislocation. Two participants discontinued treatment due to adverse events unrelated to fexinidazole. Interpretation: The fexinidazole regimens in this study had an acceptable safety profile but did not prove effective against T cruzi infection. Development of fexinidazole monotherapy for treating T cruzi infection has been stopped. Funding: The Drugs for Neglected Diseases initiative.
UR - http://www.scopus.com/inward/record.url?scp=85182008377&partnerID=8YFLogxK
UR - https://pubmed.ncbi.nlm.nih.gov/38218194
U2 - 10.1016/S1473-3099(23)00651-5
DO - 10.1016/S1473-3099(23)00651-5
M3 - Article
C2 - 38218194
AN - SCOPUS:85182008377
SN - 1473-3099
VL - 24
SP - 395
EP - 403
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 4
ER -