Eficacia de la monoterapia versus la terapia combinada para el tratamiento de la enfermedad de Chagas: revisión sistemática.

Abstract

Introduction: A systematic review of the effectiveness of monotherapy and combination therapy for Chagas disease. Objective: To evaluate the effectiveness of monotherapy versus combined therapy in treating Chagas disease, focusing on its impact on parasitemia reduction, clinical outcomes, and adverse effects. Methodology: Randomized clinical trials (2012–2024) involving patients diagnosed in acute or chronic phases were included. Reviews, theses, and non-randomized studies were excluded. Information sources included databases such as Scopus, PubMed, EMBASE, and ClinicalTrials.gov, with the last search conducted in November 2024. The Cochrane Collaboration assessed the risk of bias using the ROB-2 tool. The results were synthesized through qualitative and quantitative analyses of the included studies. Results: Twenty studies (randomized clinical trials and case-control studies) involving 2,841 patients were analyzed. Monotherapy with benznidazole showed an average efficacy of 80%-89% in achieving negative seroconversion in parasitological counts but was associated with adverse effects (rash, neuropathies). Combination therapy with benznidazole and posaconazole or nifurtimox increased efficacy to 86%-96%, albeit with a higher incidence of severe side effects. Alternatives such as fexinidazole demonstrated better tolerance but lower comparative efficacy. Conclusions: Benznidazole remains the reference treatment for Chagas disease, especially in acute phases. Combination therapy offers higher parasite elimination rates but is limited by increased adverse effects, restricting its use in vulnerable populations. Findings support a personalized approach that considers the clinical status and patient tolerance to optimize outcomes. Keywords: Chagas, monotherapy, combined therapy, pharmacological treatment, therapeutic efficacy