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The Safety and Effectiveness of Hydroxyurea and ddI Used Individually or Together in HIV-Infected Patients

A Phase I/II Dosing Study of the Safety and Antiretroviral Activity of Hydroxyurea Alone and in Combination With ddI Compared With ddI Alone in Subjects With HIV Infection

To determine the safety and tolerability of hydroxyurea at two doses alone and in combination with didanosine (ddI). To compare the short term antiviral effect of ddI monotherapy versus hydroxyurea plus ddI, as measured by plasma RNA levels at 8 weeks of therapy. [AS PER AMENDMENT 10/1/97: Accrual to arms involving hydroxyurea alone has been closed.] Current antiviral therapies for HIV-1 are limited by a few choices, and the lack of sustained clinical benefit from the drugs. The mechanisms that account for the lack of prolonged inhibition of viral replication by these agents are not fully understood. The activity of RT inhibitors might be potentiated by inhibiting host cellular enzymes essential for efficient HIV reverse transcription. Based on this information, comparisons of the antiviral effects of ddI monotherapy and hydroxyurea plus ddI, with the cellular enzyme ribonucleotide reductase as a potential target, should be done.

Descripción general del estudio

Estado

Terminado

Condiciones

Intervención / Tratamiento

Descripción detallada

Current antiviral therapies for HIV-1 are limited by a few choices, and the lack of sustained clinical benefit from the drugs. The mechanisms that account for the lack of prolonged inhibition of viral replication by these agents are not fully understood. The activity of RT inhibitors might be potentiated by inhibiting host cellular enzymes essential for efficient HIV reverse transcription. Based on this information, comparisons of the antiviral effects of ddI monotherapy and hydroxyurea plus ddI, with the cellular enzyme ribonucleotide reductase as a potential target, should be done.

This is a 24-week study, with two 12-week treatment periods. Patients are randomized to one of five treatment arms based upon a patient's history of antiretroviral therapy (naive vs. experienced). The five treatment arms are:

  1. ddI plus hydroxyurea placebo.
  2. hydroxyurea (lower dose) plus ddI placebo for 4 weeks; then hydroxyurea (higher dose) plus ddI.
  3. hydroxyurea (higher dose) plus ddI placebo for 4 weeks; then hydroxyurea (higher dose) plus ddI.
  4. hydroxyurea (lower dose) plus ddI.
  5. hydroxyurea (higher dose) plus ddI. After the completion of week 12, patients on combination therapy remain on their current therapy and patients on ddI plus placebo have hydroxyurea replace the placebo at 1 of 2 assigned doses (1:1 randomization). AS PER AMENDMENT 5/5/97: If after the 24-week treatment period, a patient has an RNA level less than or equal to 5,000 copies/ml or less than 20,000 copies/ml with a greater than 1 log10 decline from baseline, she has the option to continue therapy open-label ddI plus hydroxyurea for an additional 24 weeks.

AS PER AMENDMENT 10/1/97: Accrual to the arms involving hydroxyurea alone has been closed. Patients are randomized to one of the three treatment arms, as follows:

  1. hydroxyurea placebo plus ddI.
  2. hydroxyurea (lower dose) plus ddI.
  3. hydroxyurea (higher dose) plus ddI.

Tipo de estudio

Intervencionista

Inscripción

140

Fase

  • Fase 1

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Ubicaciones de estudio

    • California
      • San Diego, California, Estados Unidos, 921036325
        • Univ of California / San Diego Treatment Ctr
      • San Francisco, California, Estados Unidos, 94115
        • Stanford at Kaiser / Kaiser Permanente Med Ctr
      • Stanford, California, Estados Unidos, 943055107
        • Stanford Univ Med Ctr
      • Torrance, California, Estados Unidos, 90502
        • Harbor UCLA Med Ctr
    • Colorado
      • Denver, Colorado, Estados Unidos, 80262
        • Univ of Colorado Health Sciences Ctr
    • Maryland
      • Baltimore, Maryland, Estados Unidos, 21287
        • Johns Hopkins Hosp
    • New York
      • New York, New York, Estados Unidos, 10003
        • Beth Israel Med Ctr
      • New York, New York, Estados Unidos, 10016
        • Bellevue Hosp / New York Univ Med Ctr
      • New York, New York, Estados Unidos, 10029
        • Mount Sinai Med Ctr
    • North Carolina
      • Chapel Hill, North Carolina, Estados Unidos, 275997215
        • Univ of North Carolina
      • Durham, North Carolina, Estados Unidos, 27710
        • Duke Univ Med Ctr
    • Ohio
      • Cincinnati, Ohio, Estados Unidos, 452670405
        • Univ of Cincinnati
      • Cleveland, Ohio, Estados Unidos, 44106
        • Case Western Reserve Univ
      • Cleveland, Ohio, Estados Unidos, 441091998
        • MetroHealth Med Ctr
    • Pennsylvania
      • Philadelphia, Pennsylvania, Estados Unidos, 19104
        • Univ of Pennsylvania at Philadelphia
      • Philadelphia, Pennsylvania, Estados Unidos, 191075098
        • Thomas Jefferson Univ Hosp
    • South Carolina
      • West Columbia, South Carolina, Estados Unidos, 29169
        • Julio Arroyo
    • Washington
      • Seattle, Washington, Estados Unidos, 981224304
        • Univ of Washington

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años y mayores (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria

Concurrent Medication:

Allowed:

AS PER AMENDMENT 5/5/97:

  • PCP prophylaxis with trimethoprim/sulfamethoxazole or Dapsone.

Patients must have:

  • HIV-1 infection.
  • AS PER AMENDMENT 5/5/97:
  • CD4 count of 200 - 700 cells/mm3 within 60 days prior to study entry.
  • AS PER AMENDMENT 10/1/97:
  • HIV RNA plasma level < 20,000 copies/ml within 60 days of enrollment (obtained at a laboratory certified to perform the Roche Monitor assay).

Exclusion Criteria

Co-existing Condition:

Patients with any of the following symptoms or conditions are excluded:

  • CMV, MAC, toxoplasmosis, or disseminated fungal infection requiring acute or chronic therapy.
  • Significant medical illness as determined by investigator.
  • Active diagnosis of any malignancy, including visceral Kaposi's sarcoma or extensive cutaneous Kaposi's sarcoma for which systemic chemotherapy is anticipated within the next 24 weeks.
  • Current Grade 2 or greater peripheral neuropathy.

Concurrent Medication:

Excluded:

  • Acute or chronic therapy for CMV, MAC, toxoplasmosis, or disseminated fungal infection.

AS PER AMENDMENT 5/5/97:

  • All antiretroviral medications other than those provided on study.
  • Systemic chemotherapy for active malignancies, including systemic treatment for KS.
  • Agents with myelosuppressive potential, including tegretol, carboplatin, carmustine, cyclophosphamide and fluorouracil.
  • Granulocyte colony stimulating factor (G-CSF) except while hydroxyurea or matching placebo is held.

Drugs associated with peripheral neuropathy, including:

  • hydralazine, disulfiram, nitrofurantoin, cisplatinum, diethyldithiocarbamate, gold, rifampin, chloramphenicol, clioquinol, ethambutol, ethionamide, glutethimide, sodium cyanate, and thalidomide.

Patients with any of the prior conditions are excluded:

  • History of transfusion dependent anemia, defined as any history of repeated transfusion with two or more units of red blood cells.
  • At the discretion of the investigator, history of pancreatitis.

Prior Medication:

Excluded:

  • More than 2 weeks prior treatment with ddI.

AS PER AMENDMENT 5/5/97:

  • Other antiretrovirals must be discontinued at least 14 days prior to randomization.
  • Prior hydroxyurea.
  • Any candidate HIV vaccine or agent with potential immune modulating effects within the past 30 days.
  • Any colony stimulating factor or erythropoietin within the past 60 days.

Prior Treatment:

Excluded:

  • Transfusion with red blood cells within the past 60 days.

Risk Behavior:

Excluded:

  • At the investigator's discretion, any active substance abuse, including alcohol abuse interfering with compliance.

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Investigadores

  • Silla de estudio: Ian Frank, MD, Division of Infectious Diseases, University of Pennsylvania
  • Silla de estudio: Joseph Eron, MD, University of North Carolina

Publicaciones y enlaces útiles

La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Finalización del estudio (Actual)

1 de enero de 2000

Fechas de registro del estudio

Enviado por primera vez

2 de noviembre de 1999

Primero enviado que cumplió con los criterios de control de calidad

30 de agosto de 2001

Publicado por primera vez (Estimar)

31 de agosto de 2001

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

1 de noviembre de 2021

Última actualización enviada que cumplió con los criterios de control de calidad

28 de octubre de 2021

Última verificación

1 de octubre de 2021

Más información

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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