Reimagining the fight against Chagas disease

Chagas disease affects approximately 6 million people, mainly in Latin America. Less than 1% of affected individuals receive proper antiparasitic treatment, and current drugs are inadequate to fight the entire spectrum of the disease. Against this background, Novartis is pursuing an end-to-end approach, with activity on three fronts: drug discovery, clinical research and health system strengthening.

In April, we joined the global community in marking the first World Chagas Day to raise awareness of this neglected disease and the resources needed for its prevention, control and elimination as a global health challenge. Further, we supported the World Heart Federation and the Inter-American Society of Cardiology in developing an end-to-end roadmap for Chagas disease. It outlines a vision for an ideal pathway of care, providing actionable recommendations for policymakers and healthcare professionals. Once health authorities can expand their focus beyond the immediate needs of the COVID-19 pandemic, we plan several roundtables with local stakeholders, using the roadmap as a tool to help overcome local barriers to comprehensive care for people with Chagas disease.

We took significant steps to advance the development of new treatments for Chagas disease. In early 2020, we launched a three-year drug discovery program for Chagas disease and cryptosporidiosis with support from the Wellcome Trust to pursue potential first-in-class treatments.

PARACHUTE-HF, our Phase IV clinical trial to assess the efficacy and safety of Entresto in people with heart failure due to chronic Chagas cardiomyopathy, was approved by the health authorities and started recruitment in Argentina, Brazil, Colombia and Mexico. Chagas cardiomyopathy accounts for the majority of deaths and disability among individuals affected by the disease. The study resumed recruitment after initial delays due to the COVID-19 pandemic and has managed to enroll 6% of the total number of patients in 2020. Our goal is to recruit approximately 900 patients with heart failure with reduced ejection fraction and confirmed Chagas disease.

We also included sub-studies in PARACHUTE-HF to better understand the underlying pathophysiology of Chagas cardiomyopathy, coordinating activities across Global Drug Development, NITD, and our country organizations in Latin America together with our academic partner, the Brazilian Clinical Research Institute. This additional assessment will collect biological samples for biomarkers, estimate the arrhythmia burden, and use magnetic resonance imaging to evaluate cardiac structure, function and fibrosis. We are confident that these findings will help advance the global community’s knowledge of Chagas disease and create new opportunities for partnerships to treat and control it.

Additionally, NITD and its academic partners have been conducting research into novel growth inhibitors for the treatment of Chagas disease and other kinetoplastid diseases. These efforts have identified a unique drug target for trypanosomatid parasitic protozoa and a new chemical tool for investigating the function of cell division. The parasites that cause Chagas disease, leishmaniasis and African sleeping sickness share a common cell cycle protein, which may be a promising new target for treatment. The study was published in Nature Microbiology in October.

We continue to work with local and international stakeholders to strengthen health systems. For example, we are collaborating with the Global Chagas Disease Coalition to develop an online medical platform for Chagas disease, which aims to build capability among healthcare professionals to adopt an integrated disease management approach. In Bolivia, we signed an agreement with the Barcelona Institute for Global Health (IS Global) to enhance awareness of Chagas disease and improve the well-being of Chagas disease patients. In Argentina, we continued to work with the Institute for Clinical Effectiveness and Health Policy to generate local evidence for healthcare system improvements at the first level of care. In Brazil and Mexico, we are exploring partnerships on community-based disease awareness and education activities to strengthen diagnosis and treatment.