Multi-center Comparison of Fluconazole (UK-49,858) and Amphotericin B as Treatment for Acute Cryptococcal Meningitis
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To compare the safety and effectiveness of fluconazole (FCZ) and amphotericin B (AMB), alone or in combination with flucytosine (FLC), as treatment for acute cryptococcal meningitis in patients who have not been treated previously or who have relapsed after a previous successful treatment.
Cryptococcal meningitis is an important cause of disease and death among patients with AIDS. Usually AMB is given either alone or with FLC to patients with this infection, but these treatments are not always effective and both have toxic effects. Animal studies and preliminary studies in humans show that FCZ is active in cryptococcal meningitis and suggest that it may be less toxic than either AMB or FLC.
Condition | Intervention |
---|---|
Meningitis, Cryptococcal HIV Infections |
Drug: Flucytosine Drug: Fluconazole Drug: Amphotericin B |
Study Type: | Interventional |
Study Design: | Intervention Model: Parallel Assignment Primary Purpose: Treatment |
Official Title: | Multi-center Comparison of Fluconazole (UK-49,858) and Amphotericin B as Treatment for Acute Cryptococcal Meningitis |
Estimated Enrollment: | 120 |
Primary Completion Date: | July 1991 (Final data collection date for primary outcome measure) |
Cryptococcal meningitis is an important cause of disease and death among patients with AIDS. Usually AMB is given either alone or with FLC to patients with this infection, but these treatments are not always effective and both have toxic effects. Animal studies and preliminary studies in humans show that FCZ is active in cryptococcal meningitis and suggest that it may be less toxic than either AMB or FLC.
Patients accepted into the study are randomly assigned to FCZ or AMB. Patients assigned to FCZ take FCZ by mouth daily for 10 weeks. Patients assigned to AMB are given intravenous injections of AMB daily for 6-10 weeks. Non-AIDS patients assigned to AMB also take FLC by mouth daily. The use of FLC in patients with AIDS is decided on an individual basis. Patients with AIDS who respond satisfactorily to FCZ receive maintenance therapy to prevent relapse for an additional 12 months. Patients with AIDS who respond to AMB may qualify for another Pfizer Central Research protocol. Patients without AIDS who respond to therapy are observed for 6 months for relapse. During therapy, samples of blood and cerebrospinal fluid (by lumbar puncture) are taken periodically in order to evaluate the effectiveness of the drug treatments and to identify possible toxic effects.
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Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria
Concurrent Medication:
Allowed:
- Immunosuppressant therapy.
- Cyclosporin plasma concentrations should be monitored and appropriate dosage adjustments made when used with amphotericin B or fluconazole.
- Antiviral therapy.
- Prophylaxis for Pneumocystis carinii pneumonia.
- Treatment of intercurrent opportunistic infection as long as no investigational agent, or approved agent for an investigational indication, is used.
- Antipyretics, hydrocortisone, or meperidine to prevent or ameliorate side effects associated with amphotericin B.
Concurrent Treatment:
Allowed:
- Radiation therapy for mucocutaneous Kaposi's sarcoma.
Patients must have:
- Written informed consent obtained from the patient or from the patient's legal guardian.
- One of the following:
- (1) Tentative identification of Cryptococcus neoformans in culture of lumbar cerebrospinal fluid (CSF). Results of baseline cultures need not be available when therapy is begun, but therapy is discontinued if the baseline CSF culture is later found to be negative for C. neoformans, or (2) Clinical and CSF findings (cell count, protein, glucose) compatible with cryptococcal meningitis plus one of the following:
- (a) Positive CSF India ink examination, (b) Culture or biopsy evidence of extraneural cryptococcal infection, (c) Positive serum of CSF cryptococcal antigen test, or increase in titer for previously treated patients with suspected relapse, or (d) Biopsy evidence of central nervous system cryptococcal infection.
- Treatment status of either no prior systemic antifungal therapy for cryptococcosis or relapse after prior therapy. The success of prior therapy must have been documented by negative CSF culture at the end of therapy.
Prior Medication:
Allowed within 4 weeks of study entry:
- Successful prior therapy for cryptococcosis, but no more than 1 mg/kg/week amphotericin B.
Allowed:
- Immunosuppressant therapy.
- Antiviral therapy.
- Prophylaxis for Pneumocystis carinii pneumonia.
Exclusion Criteria
Co-existing Condition:
Excluded:
- Acute or chronic meningitis based on any etiology other than cryptococcosis.
- History of allergy to or intolerance of imidazoles, or amphotericin B.
- Moderate or severe liver disease defined as any one or more of the following:
- SGOT or SGPT > 5 x upper limit of normal, total bilirubin > 2.5 mg/dl, prothrombin time > 5 seconds over control, or alkaline phosphatase > 2 x upper limit of normal.
- Comatose patients.
Concurrent Medication:
Excluded:
- Drugs with low therapeutic ratios that undergo hepatic metabolism may not be used with fluconazole until possible drug interactions have been clarified.
- Coumarin-type anticoagulants.
- Oral hypoglycemics.
- Barbiturates.
- Immunostimulants.
- Investigational drugs or approved (licensed) drugs for investigational indications.
- Systemic antifungal agent other than the assigned study drug.
Concurrent Treatment:
Excluded:
Lymphocyte replacement.
Prior Medication:
Excluded within 4 weeks of study entry:
- More than 1 mg/kg/week amphotericin B.
Patients unlikely to survive more than 2 weeks.
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United States, Florida | |
Univ of Miami School of Medicine | |
Miami, Florida, United States, 331361013 | |
United States, Louisiana | |
Tulane Univ School of Medicine | |
New Orleans, Louisiana, United States, 70112 | |
United States, New York | |
Bronx Municipal Hosp Ctr/Jacobi Med Ctr | |
Bronx, New York, United States, 10461 | |
Mem Sloan - Kettering Cancer Ctr | |
New York, New York, United States, 10021 | |
United States, North Carolina | |
Univ of North Carolina | |
Chapel Hill, North Carolina, United States, 275997215 | |
United States, South Carolina | |
Julio Arroyo | |
West Columbia, South Carolina, United States, 29169 |
Study Chair: | Armstrong D |
![](https://webarchive.library.unt.edu/web/20130312224250im_/http://clinicaltrials.gov/ct2/html/images/frame/triangle.gif)
Additional Information:
Publications:
ClinicalTrials.gov Identifier: | NCT00000708 History of Changes |
Other Study ID Numbers: | ACTG 059, Protocol 159, Project 056, Investigator 556 |
Study First Received: | November 2, 1999 |
Last Updated: | March 11, 2011 |
Health Authority: | United States: Federal Government |
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
AIDS-Related Opportunistic Infections Meningitis Injections, Intravenous Cryptococcus neoformans Cryptococcosis |
Drug Therapy, Combination Fluconazole Administration, Oral Acquired Immunodeficiency Syndrome Amphotericin B |
Additional relevant MeSH terms:
HIV Infections Acquired Immunodeficiency Syndrome Meningitis Meningitis, Cryptococcal Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Slow Virus Diseases Central Nervous System Infections Central Nervous System Diseases |
Nervous System Diseases Meningitis, Fungal Central Nervous System Fungal Infections Mycoses Cryptococcosis Amphotericin B Liposomal amphotericin B Fluconazole Flucytosine Amebicides Antiprotozoal Agents Antiparasitic Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on March 10, 2013