Efficacy and safety of fexinidazole for treatment of chronic indeterminate Chagas disease (FEXI-12) : a multicentre, randomised, double-blind, phase 2 trial
Copyright © 2024 Elsevier Ltd. All rights reserved..
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
|---|---|
| Enthalten in: |
The Lancet. Infectious diseases - 24(2024), 4 vom: 31. März, Seite 395-403 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Pinazo, Maria-Jesus [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
306ERL82IR |
|---|
| Anmerkungen: |
Date Completed 25.03.2024 Date Revised 25.03.2024 published: Print-Electronic ClinicalTrials.gov: NCT03587766 Citation Status MEDLINE |
|---|
| doi: |
10.1016/S1473-3099(23)00651-5 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM367087472 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM367087472 | ||
| 003 | DE-627 | ||
| 005 | 20240325234632.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240114s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/S1473-3099(23)00651-5 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1346.xml |
| 035 | |a (DE-627)NLM367087472 | ||
| 035 | |a (NLM)38218194 | ||
| 035 | |a (PII)S1473-3099(23)00651-5 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Pinazo, Maria-Jesus |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Efficacy and safety of fexinidazole for treatment of chronic indeterminate Chagas disease (FEXI-12) |b a multicentre, randomised, double-blind, phase 2 trial |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.03.2024 | ||
| 500 | |a Date Revised 25.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT03587766 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Elsevier Ltd. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a FUNDING: The Drugs for Neglected Diseases initiative | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Clinical Trial, Phase II | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a fexinidazole |2 NLM | |
| 650 | 7 | |a 306ERL82IR |2 NLM | |
| 650 | 7 | |a Nifurtimox |2 NLM | |
| 650 | 7 | |a M84I3K7C2O |2 NLM | |
| 650 | 7 | |a Nitroimidazoles |2 NLM | |
| 700 | 1 | |a Forsyth, Colin |e verfasserin |4 aut | |
| 700 | 1 | |a Losada, Irene |e verfasserin |4 aut | |
| 700 | 1 | |a Esteban, Elena Trigo |e verfasserin |4 aut | |
| 700 | 1 | |a García-Rodríguez, Magdalena |e verfasserin |4 aut | |
| 700 | 1 | |a Villegas, Maria Luz |e verfasserin |4 aut | |
| 700 | 1 | |a Molina, Israel |e verfasserin |4 aut | |
| 700 | 1 | |a Crespillo-Andújar, Clara |e verfasserin |4 aut | |
| 700 | 1 | |a Gállego, Montserrat |e verfasserin |4 aut | |
| 700 | 1 | |a Ballart, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a Ramirez, Juan Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Aden, Tilman |e verfasserin |4 aut | |
| 700 | 1 | |a Hoerauf, Achim |e verfasserin |4 aut | |
| 700 | 1 | |a Pfarr, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Vaillant, Michel |e verfasserin |4 aut | |
| 700 | 1 | |a Marques, Tayná |e verfasserin |4 aut | |
| 700 | 1 | |a Fernandes, Jayme |e verfasserin |4 aut | |
| 700 | 1 | |a Blum, Bethania |e verfasserin |4 aut | |
| 700 | 1 | |a Ribeiro, Isabela |e verfasserin |4 aut | |
| 700 | 1 | |a Sosa-Estani, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Barreira, Fabiana |e verfasserin |4 aut | |
| 700 | 1 | |a Gascón, Joaquim |e verfasserin |4 aut | |
| 700 | 0 | |a FEXI-12 Study Team |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Lancet. Infectious diseases |d 2001 |g 24(2024), 4 vom: 31. März, Seite 395-403 |w (DE-627)NLM117564362 |x 1474-4457 |7 nnns |
| 773 | 1 | 8 | |g volume:24 |g year:2024 |g number:4 |g day:31 |g month:03 |g pages:395-403 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/S1473-3099(23)00651-5 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 24 |j 2024 |e 4 |b 31 |c 03 |h 395-403 | ||