A Study of Foscarnet Plus Ganciclovir in the Treatment of Cytomegalovirus of the Eye in Patients With AIDS Who Have Already Been Treated With Ganciclovir

NCT00000970 | Completed Phase 1

• 2 other identifiers: ACTG 15111126
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 6

Brief Summary

To examine the safety and tolerance of the administration of ganciclovir and foscarnet given together or alternately; to determine the interactive pharmacokinetics (blood level) profile of long-term combined and alternating therapy with these two drugs. Additional objectives are to examine the effect of these treatments in controlling time to cytomegalovirus (CMV) retinitis progression and to examine the antiviral activity of combined and alternating ganciclovir/foscarnet treatment and development of antiviral resistance. Sight-threatening CMV retinitis occurs in at least 6 percent of AIDS patients. By 1991 (US), there may be 6000 to 10000 patients with CMV retinitis. Many clinical reports suggest that both ganciclovir (DHPG) and foscarnet have an antiviral effect against CMV that is often associated with clinical stabilization. Effectiveness of ganciclovir and foscarnet is correlated with weekly maintenance and since toxicity is dose-limiting in up to 20 percent of patients receiving either drug for long periods, it may be beneficial in long-term maintenance treatment to combine or alternate these two drugs at a lower total weekly dose of each drug. This strategy may result in a greater net antiviral effect with less toxicity than is seen with either drug alone, because the toxicities of each drug are quite different.

Conditions

Cytomegalovirus Retinitis; HIV Infections

Keywords

Retinitis; AIDS-Related Opportunistic Infections; Ganciclovir; Drug Evaluation; Drug Therapy, Combination; Foscarnet; Cytomegalovirus Infections; Acquired Immunodeficiency Syndrome

Interventions

Foscarnet sodium DRUG

Ganciclovir DRUG

Eligibility Criteria

• Age: 13 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Concurrent Medication:
• Allowed:
• Chemotherapy for Kaposi's sarcoma (excluding interferon) if patient is hematologically stable for at least 30 days prior to entry.
• Zidovudine (AZT), dideoxyinosine (ddI), dideoxycytidine (ddC) after first two weeks of study period if absolute neutrophil count is \> 1000 cells/mm3 and hemoglobin = or \> 8 g/dl.
• Vancomycin.
• Fluconazole or investigational triazoles (e.g., itraconazole, SCH 39304) for disseminated fungal infection.
• Pneumocystis carinii pneumonia prophylaxis (except parenteral pentamidine).
• Acyclovir or other appropriate medication may be instituted in the event of the appearance of Herpes simplex virus
• (HSV) or Varicella zoster virus (VZV) infections.
• G-CSF or GM-CSF for grade 4 neutropenia.
• Concurrent Treatment:
• Allowed:
• Recombinant human erythropoietin.
• Prior Medication: Required:
• Completion of 14-day course of intravenous ganciclovir induction therapy (2.5 mg/kg IV q8h or 5 mg/kg q12h for 14 days) or foscarnet induction therapy (60 mg/kg q8h adjusted for renal function for 14 days) within 1 week prior to study entry. Patients who do not initiate the study immediately upon completing ganciclovir induction therapy should receive a maintenance ganciclovir regimen of 5 mg/kg/day or 6 mg/kg/day 5 x week or a foscarnet regimen of 90-120 mg/kg/day until initiating study drug.

You may not qualify if:

• Co-existing Condition:
• Patients with the following conditions or symptoms are excluded:
• Evidence of tuberculous, diabetic or hypertensive retinopathy.
• Osteomalacia, neoplasm metastatic to bone or other bone disease.
• Any clinically significant pulmonary or neurologic impairment (for example, patients who are intubated or comatose).
• Retinal detachment.
• Corneal, lens, or vitreous opacification precluding funduscopic exam.
• Concurrent Medication:
• Excluded:
• Immunomodulators, biologic response modifiers or investigational agents not specifically allowed.
• Aminoglycosides, amphotericin B, probenecid, parenteral pentamidine.
• Zidovudine (AZT), dideoxyinosine (ddI), dideoxycytidine (ddC) until completion of second week of maintenance therapy. ddC use is discouraged but not prohibited because of paucity of experience of this drug with ganciclovir and foscarnet.
• Anti-cytomegalovirus (CMV) therapy:
• Ganciclovir, CMV hyperimmune serum/globulin, interferons, immunomodulators.
• Prophylactic antiviral therapy with acyclovir.

Sponsors & Collaborators

• National Institute of Allergy and Infectious Diseases (NIAID): lead
• Astra USA: collaborator
• Hoffmann-La Roche: collaborator

Study Sites (6)

USC CRS

Los Angeles, California, 90033, United States

Location

Ucsf Aids Crs

San Francisco, California, United States

Location

Washington U CRS

St Louis, Missouri, United States

Location

Memorial Sloan-Kettering Cancer Ctr.

New York, New York, 10021, United States

Location

Unc Aids Crs

Chapel Hill, North Carolina, 27599, United States

Location

University of Washington AIDS CRS

Seattle, Washington, 98122, United States

Location

Related Publications (2)

• Jacobson MA, Kramer F, Bassiakos Y, Hooton T, Polsky B, Geheb H, O'Donnell JJ, Walker JD, Korvick JA, van der Horst C. Randomized phase I trial of two different combination foscarnet and ganciclovir chronic maintenance therapy regimens for AIDS patients with cytomegalovirus retinitis: AIDS clinical Trials Group Protocol 151. J Infect Dis. 1994 Jul;170(1):189-93. doi: 10.1093/infdis/170.1.189.

  PMID: 8014496 BACKGROUND

• Aweeka FT, Gambertoglio JG, Kramer F, van der Horst C, Polsky B, Jayewardene A, Lizak P, Emrick L, Tong W, Jacobson MA. Foscarnet and ganciclovir pharmacokinetics during concomitant or alternating maintenance therapy for AIDS-related cytomegalovirus retinitis. Clin Pharmacol Ther. 1995 Apr;57(4):403-12. doi: 10.1016/0009-9236(95)90209-0.

  PMID: 7712668 BACKGROUND

MeSH Terms

Conditions

Cytomegalovirus Retinitis; HIV Infections; Retinitis; AIDS-Related Opportunistic Infections; Multiple Acyl Coenzyme A Dehydrogenase Deficiency; Cytomegalovirus Infections; Acquired Immunodeficiency Syndrome

Interventions

Foscarnet; Ganciclovir

Condition Hierarchy (Ancestors)

Eye Infections, Viral; Eye Infections; Infections; Herpesviridae Infections; DNA Virus Infections; Virus Diseases; Eye Diseases; Retinal Diseases; Blood-Borne Infections; Communicable Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Genital Diseases; Urogenital Diseases; Immunologic Deficiency Syndromes; Immune System Diseases; Opportunistic Infections; Amino Acid Metabolism, Inborn Errors; Metabolism, Inborn Errors; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Metabolic Diseases; Nutritional and Metabolic Diseases; Mitochondrial Diseases; Slow Virus Diseases

Intervention Hierarchy (Ancestors)

Phosphonoacetic Acid; Acetates; Acids, Acyclic; Carboxylic Acids; Organic Chemicals; Organophosphonates; Organophosphorus Compounds; Acyclovir; Guanine; Hypoxanthines; Purinones; Purines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds

Study Officials

• Jacobson MA

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: phase 1
• Purpose: TREATMENT
• Sponsor Type: NIH
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 2, 1999
• First Posted: August 31, 2001
• Study Completion: June 1, 1993
• Last Updated: November 4, 2021

Record last verified: 2021-10

Locations

US (6)