A new treatment for Chagas disease
  • RFP Year
  • Awarded Amount
  • Disease
    NTD (Chagas disease)
  • Intervention
  • Development Stage
    Clinical Phase2
  • Collaboration Partners
    Eisai Co., Ltd., Drugs for Neglected Diseases initiative

Introduction and Background of the Project

Chagas disease is a global public health problem, particularly in the poorer areas of Latin America and the Caribbean. About 8 million people are believed to be infected, and about a third of these - if left untreated - will develop serious heart or intestinal damage that could lead to death. Two currently used drugs, discovered decades ago, have variable efficacy in treatment of the chronic phase of the disease and an unsatisfactory tolerability profile in adults. In this context, the development of a new treatment effective for the chronic phase of the disease with similar or improved efficacy but a better tolerability profile, particularly in adults, would represent a breakthrough.

DNDi and Eisai joined efforts to conduct a Phase 2, proof-of-concept study of the combination of E1224, a new generation triazole compound with potent inhibitory activity against ergosterol biosynthesis, and the reference drug, Benznidazole, in standard and reduced dosing regimens, to provide a new treatment strategy for Chagas Disease.  In preparation for future registration, all required chemistry, manufacturing, and controls activities and nonclinical tests will be conducted.

How can your partnership (project) address global health challenges?

Chagas disease is one of the world’s most neglected diseases. There is global consensus that new treatment alternatives are needed. Chagas disease is recognized by the World Health Organization (WHO) among the “tool-deficient” neglected tropical diseases, a so-called Type III disease.  

DNDi and Eisai aim to develop a new effective treatment for Chagas disease that is oral, easy to use, safe, and affordable to address the population’s needs. The challenges of access in Chagas disease cannot be over-emphasized. Today, a very small fraction of patients with Chagas disease receive treatment. Access issues are considered from the start of this joint development in order to maximize the regimen’s availability and future adoption. 

Broad registration of the new treatment regimen is planned upon conclusion of Phase 3 studies, with an initial focus on the countries with the highest burden of disease, but also to include stringent regulatory authorities. In addition, early submission for inclusion of the combination in the WHO Essential Medicines List would be targeted.

What sort of innovation are you bringing in your project?

This project targets the development of an innovative new effective treatment regimen for Chagas disease that is oral, easy to use, safe, and affordable.

E1224, developed by Eisai Co., is the water-soluble monolysine salt of a phosphonoxymethyl ether of ravuconazole (RAV) and is rapidly converted to RAV in mammalian species. Benznidazole is the current first line treatment for Chagas disease in most countries. Current treatment regimens and dosing intervals have been derived from decades-old patient studies and with very limited direct comparisons. Treatment recommendations vary significantly from country to country and the comparative evidence-base with the current treatment regimens is limited.

Leveraging data obtained from the recently completed Phase Ⅱ, randomized, blind, comparative trial of three regimens of E1224 and one of BZN versus placebo, the current project will evaluate different treatment regimens of E1224 and Benznidazole for the treatment of adults of chronic indeterminate Chagas disease.

Combination therapy is a well-recognized treatment modality in many disease settings, including cancer, cardiovascular disease, and infectious diseases. Infectious diseases such as tuberculosis, malaria, leprosy, and HIV only came under control and were effectively treated only after introduction of combinations of drugs that utilize different mechanisms of action. 

Role and Responsibility of Each Partner

Eisai will provide the chemistry, manufacturing, and control of the drug product and substance. Eisai will also provide supplies of the drug for the clinical studies.  As collaborating partner, the principal investigators will lend their scientific expertise in clinical development and lead and perform specific clinical and preclinical studies such as a human mass balance study. 

DNDi as principal investigator will be responsible for the clinical development of E1224, a pro-drug of ravuconazole, use in patients with Chagas disease (CD) in endemic countries.  Specifically, DNDi will conduct a drug-drug interaction study, will initiate the Phase II Proof-of-Concept study, with its partners, and recruit patients for the trial.  For implementation of clinical trials, DNDi will work with Eisai and the Chagas Disease Clinical Trial Platform, a network of CD clinicians and researchers from endemic countries established in 2009, who strengthens clinical research capacity and facilitates assessments of new and promising interventions.