MMWR Morb Mortal Wkly Rep. 2018 Jul 27;67(29):803-805. doi: 10.15585/mmwr.mm6729a3.
Chagas disease (also known as American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi (1,2). Vectorborne transmission via skin or mucosal contact with the feces of infected triatomine bugs mainly occurs in rural areas of Latin America but has been reported in the southern United States (3). The parasite also is transmissible congenitally and via blood transfusion, organ transplantation, and accidental laboratory exposures. The two drugs used for treating Chagas disease are benznidazole and nifurtimox (1,2), which have been used in Latin America since the 1970s and 1960s, respectively. In the absence of commercially available drugs approved by the Food and Drug Administration (FDA), benznidazole and nifurtimox have been available exclusively through CDC, under Investigational New Drug (IND) treatment protocols. On August 29, 2017, FDA approved a benznidazole product (Chemo Research, SL, in care of Exeltis*) for treatment of Chagas disease (4), which became commercially available on May 14, 2018. Therefore, effective May 14, 2018, benznidazole is no longer available through the CDC-sponsored IND program. This report summarizes selected characteristics of patients for whom CDC released benznidazole through that program from October 2011, when the IND went into effect, until mid-May 2018. The majority of the 365 patients included in intention-to-treat analyses were chronically infected adults who were born and became infected in Latin America. Physician requests for benznidazole should now be directed to the drug company Exeltis. The CDC-sponsored IND for nifurtimox remains in effect to provide an alternative therapeutic option to benznidazole when clinically appropriate. CDC will continue to provide reference diagnostic testing for T. cruzi infection and teleconsultative services regarding Chagas disease.
恰加斯病(也称为美洲锥虫病)是由原生动物寄生虫克氏锥虫引起的(1,2)。通过与受感染的三锥虫粪便的皮肤或粘膜接触,主要通过媒介传播,这种情况主要发生在拉丁美洲的农村地区,但也有报道称在美国南部发生(3)。寄生虫也可以通过先天性传播、输血、器官移植和意外实验室暴露传播。用于治疗恰加斯病的两种药物是苯硝唑和硝呋替莫(1,2),它们分别于 20 世纪 70 年代和 60 年代在拉丁美洲使用。在没有食品和药物管理局(FDA)批准的商业上可获得的药物的情况下,苯硝唑和硝呋替莫仅通过疾病预防控制中心,根据调查性新药(IND)治疗方案获得。2017 年 8 月 29 日,FDA 批准了苯硝唑产品(Chemo Research, SL,由 Exeltis*负责)用于治疗恰加斯病(4),该产品于 2018 年 5 月 14 日开始商业销售。因此,自 2018 年 5 月 14 日起,CDC 赞助的 IND 方案不再提供苯硝唑。本报告总结了自 2011 年 IND 生效以来,CDC 通过该方案发布苯硝唑的患者的一些特征,这些患者的 IND 于 2011 年 10 月生效,直至 2018 年 5 月中旬。意向治疗分析中包括的 365 名患者大多数为慢性感染的成年人,他们在拉丁美洲出生并感染。现在,医生应将苯硝唑的处方要求直接提交给 Exeltis 公司。CDC 赞助的硝呋替莫 IND 仍然有效,为临床上适当的苯硝唑提供了另一种治疗选择。CDC 将继续提供克氏锥虫感染的参考诊断检测和恰加斯病的远程咨询服务。