Molina Israel, Salvador Fernando, Sánchez-Montalvá Adrián
Department of Infectious Disease, Vall d'Hebron Teaching Hospital, International Health Program of the Catalan Institute of Health (PROSICS) Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain.
Curr Opin Infect Dis. 2015 Oct;28(5):397-407. doi: 10.1097/QCO.0000000000000192.
The current therapeutic scenario against Chagas disease has been recently updated with the use of the triazoles in clinical trials and several experimental assays (in-vitro and in-vivo models) which are bringing novel and promising evidence for the treatment of Chagas diseases, mainly in its chronic phase. We pretend to analyze all the evidence extracted from the in-vitro and in-vivo assays, and try to understand the poor outcome of posaconazole (POS) in the clinical experience.
POS is the drug with more advanced development in both experimental model and clinical trial. Despite the promising results initially obtained in the animal model, the clinical trial did not meet expectations. Nevertheless, it has documented the activity against Trypanosoma cruzi either in the animal model or in humans. Also new treatment strategies, combination or sequential schemes, have been evaluated in the animal model.
POS has been tested in humans showing activity against T. cruzi, but not enough to reach cure by itself. Those results represent one of the most important breakthroughs in the treatment of Chagas disease, and open a window to new strategies as combination therapies or even sequential treatments.
针对恰加斯病的当前治疗方案最近因三唑类药物在临床试验和若干实验测定(体外和体内模型)中的应用而得到更新,这些研究为恰加斯病的治疗,主要是慢性期治疗,带来了新的且有前景的证据。我们旨在分析从体外和体内测定中获取的所有证据,并试图理解泊沙康唑(POS)在临床实践中疗效不佳的原因。
POS是在实验模型和临床试验中研发进展最为深入的药物。尽管最初在动物模型中取得了令人鼓舞的结果,但临床试验并未达到预期。然而,它在动物模型或人体中均已证明对克氏锥虫具有活性。此外,新的治疗策略,如联合或序贯方案,也已在动物模型中进行了评估。
POS已在人体中进行了测试,显示出对克氏锥虫的活性,但仅凭其自身尚不足以实现治愈。这些结果代表了恰加斯病治疗中最重要的突破之一,并为联合治疗甚至序贯治疗等新策略打开了一扇窗。