Pharmacotherapeutic follow-up of patients with Chagas disease using benznidazole: drug-related problems and pharmaceutical interventions

Abstract INTRODUCTION Benznidazole (BNZ) is a drug available for the etiological treatment of Chagas disease. However, this drug is toxic and has a limited effectiveness on the chronic phase of this disease, often leading to poor treatment adherence. METHODS: This is a descriptive and exploratory study conducted at the Pharmaceutical Care Service for Chagas disease patients of the Federal University of Ceará. Drug-related problems (DRPs) and pharmaceutical interventions (PIs) were classified according to the Second Consensus of Granada. RESULTS: The average age of patients with Chagas disease was 62 years, with the majority residing in the Ceará countryside (86.7%), and having low education levels (63.3% with elementary school education). Regarding family income, most patients belonged to a household that earned ≤1-2 times the minimum wage per month. Approximately 73% of these patients complied with the BNZ treatment, and nearly 7% underwent therapy interruption after medical evaluation. A total of 189 DRPs were identified, of which 51.9% (n=98) were classified as potential, and 48.1% (n=91) as actual. The most frequent DRPs were related to safety (qualitative safety; n=70; 37%), necessity (non-adherence; n=52; 27.5%), and effectiveness (qualitative effectiveness/non-optimal drug selection; n=45; 23.8%). Among the 216 PIs conducted, the majority were related to patient education (n=168; 77.8%) and pharmacological strategy (n=42; 19.4%). CONCLUSIONS: This study indicates the need for pharmacotherapeutic monitoring in patients with Chagas because of the high number of therapeutic interventions, DRPs (approximately 3 DRPs/patient), BNZ adherence, and polypharmacy.

摘要
引言：苯硝唑（Benznidazole，BNZ）是用于恰加斯病（Chagas disease）病因治疗的药物。然而，该药物具有毒性，且对该病慢性期的疗效有限，常导致治疗依从性不佳。
方法：本研究为描述性探索性研究，在塞阿拉联邦大学查加斯病患者药学服务站点开展。根据格拉纳达第二次共识对药物相关问题（Drug-related problems，DRPs）与药学干预（Pharmaceutical Interventions，PIs）进行分类。
结果：恰加斯病患者的平均年龄为62岁，大多数患者居住在塞阿拉农村地区（86.7%），受教育水平较低（63.3%仅完成小学教育）。在家庭收入方面，多数患者的家庭月收入不超过最低工资的1-2倍。约73%的患者依从苯硝唑治疗，近7%的患者经医学评估后中断了治疗。共识别出189例药物相关问题，其中51.9%（n=98）被归类为潜在药物相关问题，48.1%（n=91）为实际药物相关问题。最常见的药物相关问题涉及安全性（定性安全性；n=70，占37.0%）、必要性（不依从；n=52，占27.5%）与有效性（定性有效性/药物选择非最优；n=45，占23.8%）。在开展的216项药学干预中，多数干预与患者教育（n=168，占77.8%）及药物治疗策略（n=42，占19.4%）相关。
结论：本研究表明，由于存在大量治疗干预、药物相关问题（平均每位患者约3个药物相关问题）、苯硝唑治疗依从性问题以及多重用药情况，需对恰加斯病患者开展药物治疗监测。