Azoles E1224

In 2009, DNDi joined forces with Eisai Co. Ltd – the Japanese pharmaceutical company that discovered E1224 – to develop this new chemical entity for Chagas disease. The Phase II proof-of-concept study started in July 2011 in Cochabamba and Tarija, Bolivia, the country which carries the world’s largest Chagas disease burden.

The study evaluated the potential of E1224 as a treatment for Chagas disease and explored promising biomarkers of therapeutic response in Chagas disease (see also Biomarkers project). This randomized, multicentre, placebo-controlled, safety and efficacy study evaluated three oral dosing regimens of E1224 and the standard dosing regimen of benznidazole (5mg/kg/day). The preliminary results, released in November 2013 at ASTMH, indicated that the experimental drug candidate E1224 was effective at clearing the parasite that causes Chagas disease at the end of the treatment course, but there was limited sustained efficacy one year after treatment as a single medication, as well as some safety issues at the highest dose. The current, standard therapy for Chagas, benznidazole, was shown to be very effective in the long term but continued to be associated with safety and tolerability concerns. Since the development of E1224 as monotherapy was discontinued, efforts were redirected toward exploring its use in combination therapy for Chagas disease. However, the results of Bendita showed that the combination did not demonstrate improved efficacy when compared to the standard of care.

Key findings from the project:

• At treatment completion, PCR-determined eradication rates of the Chagas parasite were 79-91% for E1224; 91% for benznidazole; 26% for placebo.
• 12 months after treatment, 8-31% of patients treated with E1224 maintained parasite clearance compared with 81% with benznidazole and 8.5% placebo.