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An Efficacy Study of 2',3'-Dideoxyinosine (ddI) (BMY-40900) Administered Orally Twice Daily to Zidovudine Intolerant Patients With AIDS or AIDS-Related Complex

11 marzo 2011 aggiornato da: National Institute of Allergy and Infectious Diseases (NIAID)

AMENDED: 8/29/90 Inclusion of asymptomatic patients with CD4 counts less than 200 cells/mm3. Standardization of baseline evaluation schedule to allow 14 days prior to study dosing. Reduction in frequency and intensity of follow-up evaluations. Standardization of study endpoints. Inclusion of toxicity scoring and management for amylase and triglyceride elevations. Clarification of concomitant medication use. Original design: To determine the effectiveness of didanosine (ddI) in patients with AIDS or advanced AIDS related complex (ARC) who have documented hematologic intolerance to zidovudine (AZT) therapy. To determine if the efficacy of ddI increases with increasing doses.

AZT is effective in reducing mortality in patients with AIDS who receive the drug after the first episode of Pneumocystis carinii pneumonia (PCP) and in patients with advanced ARC. However, AZT therapy has been associated with significant toxicities. In addition, the effectiveness of AZT appears to decrease during the second and third years of therapy. For these reasons, the development of alternative therapy that would be at least as effective but less toxic is of great importance. The drug ddI is an antiviral agent that inhibits replication (reproduction) of HIV with less apparent toxicity than AZT. The major dose-limiting toxicities found in the Phase I studies have been pains in the feet and legs of 2 patients initially receiving 12 mg/kg/day and 12 patients receiving daily doses of 25.8 to 51.2 mg/kg; symptoms began 8 to 27 weeks after initiating ddI treatment. These neuropathy-like symptoms have generally not been associated with significant abnormalities in nerve conduction studies and patients have reported marked improvement in symptoms within 1 to 2 weeks of discontinuing ddI. Some patients have resumed ddI treatment at a reduced dose after resolution of their symptoms. Studies indicate that ddI remains active in the body for at least 12 hours. This indicates that benefits of ddI might be achieved with a low frequency of drug administration.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

AZT is effective in reducing mortality in patients with AIDS who receive the drug after the first episode of Pneumocystis carinii pneumonia (PCP) and in patients with advanced ARC. However, AZT therapy has been associated with significant toxicities. In addition, the effectiveness of AZT appears to decrease during the second and third years of therapy. For these reasons, the development of alternative therapy that would be at least as effective but less toxic is of great importance. The drug ddI is an antiviral agent that inhibits replication (reproduction) of HIV with less apparent toxicity than AZT. The major dose-limiting toxicities found in the Phase I studies have been pains in the feet and legs of 2 patients initially receiving 12 mg/kg/day and 12 patients receiving daily doses of 25.8 to 51.2 mg/kg; symptoms began 8 to 27 weeks after initiating ddI treatment. These neuropathy-like symptoms have generally not been associated with significant abnormalities in nerve conduction studies and patients have reported marked improvement in symptoms within 1 to 2 weeks of discontinuing ddI. Some patients have resumed ddI treatment at a reduced dose after resolution of their symptoms. Studies indicate that ddI remains active in the body for at least 12 hours. This indicates that benefits of ddI might be achieved with a low frequency of drug administration.

Patients are randomized to one of three ddI treatment groups; within each group, doses will be adjusted according to patient's weight at study entry. Stratification is by diagnosis of AIDS or AIDS related complex (ARC) and Medical Center. Data will be tabulated for the Data and Safety Monitoring Board at 3 month intervals.

Tipo di studio

Interventistico

Iscrizione

660

Fase

  • Fase 2

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

  • Porto Rico
      • San Juan, Porto Rico, 009275800
        • San Juan Veterans Administration Med Ctr
  • Stati Uniti
    • California
      • Los Angeles, California, Stati Uniti, 90033
        • Los Angeles County - USC Med Ctr
      • Los Angeles, California, Stati Uniti, 900481804
        • Cedars Sinai / UCLA Med Ctr
      • Los Angeles, California, Stati Uniti, 905022004
        • Harbor - UCLA Med Ctr / UCLA School of Medicine
      • Los Angeles, California, Stati Uniti, 900951752
        • UCLA Med Ctr / Pediatric
      • Palo Alto, California, Stati Uniti, 94304
        • Palo Alto Veterans Adm Med Ctr / Stanford Univ
      • San Diego, California, Stati Uniti, 921036325
        • Univ of California / San Diego Treatment Ctr
      • Stanford, California, Stati Uniti, 94305
        • Stanford Univ School of Medicine
      • Sylmar, California, Stati Uniti, 91342
        • Olive View Med Ctr
      • Sylmar, California, Stati Uniti, 91342
        • Sepulveda Veterans Adm Med Ctr / Olive View Med Ctr
      • Torrance, California, Stati Uniti, 90502
        • Harbor UCLA Med Ctr
    • Colorado
      • Denver, Colorado, Stati Uniti, 80262
        • Univ of Colorado Health Sciences Ctr
      • Denver, Colorado, Stati Uniti, 80262
        • Mountain States Regional Hemophilia Ctr / Univ of Colorado
    • District of Columbia
      • Washington, District of Columbia, Stati Uniti, 20037
        • George Washington Univ Med Ctr
    • Florida
      • Fort Lauderdale, Florida, Stati Uniti, 33316
        • G E Morey Jr
      • Miami, Florida, Stati Uniti, 331361013
        • Univ of Miami School of Medicine
      • Tampa, Florida, Stati Uniti, 33612
        • Univ of South Florida
    • Illinois
      • Chicago, Illinois, Stati Uniti, 60611
        • Northwestern Univ Med School
      • Hines, Illinois, Stati Uniti, 60141
        • Edward Hines Veterans Administration Hosp
    • Indiana
      • Indianapolis, Indiana, Stati Uniti, 462025250
        • Indiana Univ Hosp
    • Kansas
      • Wichita, Kansas, Stati Uniti, 67214
        • Univ of Kansas School of Medicine
    • Louisiana
      • New Orleans, Louisiana, Stati Uniti, 70112
        • Louisiana Comprehensive Hemophilia Care Ctr
      • New Orleans, Louisiana, Stati Uniti, 70112
        • Louisiana State Univ Med Ctr / Tulane Med School
      • New Orleans, Louisiana, Stati Uniti, 70112
        • Tulane Univ School of Medicine
    • Maryland
      • Baltimore, Maryland, Stati Uniti, 21287
        • Johns Hopkins Hosp
    • Massachusetts
      • Boston, Massachusetts, Stati Uniti, 02114
        • Harvard (Massachusetts Gen Hosp)
      • Boston, Massachusetts, Stati Uniti, 02118
        • Boston Med Ctr
      • Boston, Massachusetts, Stati Uniti, 02215
        • Beth Israel Deaconess - West Campus
      • Boston, Massachusetts, Stati Uniti, 02215
        • Beth Israel Deaconess Med Ctr
      • Springfield, Massachusetts, Stati Uniti, 01199
        • Baystate Med Ctr of Springfield
      • Worcester, Massachusetts, Stati Uniti, 01605
        • Med Ctr of Central Massachusetts
      • Worcester, Massachusetts, Stati Uniti, 01655
        • Univ of Massachusetts Med Ctr
    • Minnesota
      • Minneapolis, Minnesota, Stati Uniti, 55455
        • Univ of Minnesota
    • Nebraska
      • Omaha, Nebraska, Stati Uniti, 68105
        • Nebraska Regional Hemophilia Ctr
    • New York
      • Bronx, New York, Stati Uniti, 10461
        • Bronx Municipal Hosp Ctr/Jacobi Med Ctr
      • Bronx, New York, Stati Uniti, 10465
        • Jack Weiler Hosp / Bronx Municipal Hosp
      • Bronx, New York, Stati Uniti, 10467
        • Montefiore Med Ctr / Bronx Municipal Hosp
      • Bronx, New York, Stati Uniti, 10468
        • Bronx Veterans Administration / Mount Sinai Hosp
      • Buffalo, New York, Stati Uniti, 14215
        • SUNY / Erie County Med Ctr at Buffalo
      • Elmhurst, New York, Stati Uniti, 11373
        • City Hosp Ctr at Elmhurst / Mount Sinai Hosp
      • New York, New York, Stati Uniti, 10003
        • Beth Israel Med Ctr / Peter Krueger Clinic
      • New York, New York, Stati Uniti, 10016
        • Bellevue Hosp / New York Univ Med Ctr
      • New York, New York, Stati Uniti, 10021
        • Mem Sloan - Kettering Cancer Ctr
      • New York, New York, Stati Uniti, 10025
        • Saint Luke's - Roosevelt Hosp Ctr
      • New York, New York, Stati Uniti, 10029
        • Mount Sinai Hemophilia Ctr / Mount Sinai Med Ctr
      • New York, New York, Stati Uniti, 10029
        • Mount Sinai Med Ctr
      • Rochester, New York, Stati Uniti, 14642
        • Univ of Rochester Medical Center
      • Stony Brook, New York, Stati Uniti, 117948153
        • SUNY - Stony Brook
      • Syracuse, New York, Stati Uniti, 13210
        • SUNY / State Univ of New York
    • North Carolina
      • Chapel Hill, North Carolina, Stati Uniti, 275997215
        • Univ of North Carolina
      • Durham, North Carolina, Stati Uniti, 27710
        • Duke Univ Med Ctr
      • Winston-Salem, North Carolina, Stati Uniti, 27103
        • Bowman Gray School of Medicine / Wake Forest Univ
    • Ohio
      • Cincinnati, Ohio, Stati Uniti, 452670405
        • Holmes Hosp / Univ of Cincinnati Med Ctr
      • Cleveland, Ohio, Stati Uniti, 44106
        • Univ Hosp of Cleveland / Case Western Reserve Univ
      • Columbus, Ohio, Stati Uniti, 432101228
        • Ohio State Univ Hosp Clinic
    • Pennsylvania
      • Hershey, Pennsylvania, Stati Uniti, 170330850
        • Milton S Hershey Med Ctr
      • Philadelphia, Pennsylvania, Stati Uniti, 19104
        • Univ of Pennsylvania
      • Pittsburgh, Pennsylvania, Stati Uniti, 15219
        • Hemophilia Ctr of Western PA / Univ of Pittsburgh
      • Pittsburgh, Pennsylvania, Stati Uniti
        • Univ of Pittsburgh Med School
    • South Carolina
      • West Columbia, South Carolina, Stati Uniti, 29169
        • Julio Arroyo
    • Tennessee
      • Knoxville, Tennessee, Stati Uniti, 37920
        • Univ of Tennessee / E Tennessee Comprehensive Hemophilia Ctr
    • Texas
      • Galveston, Texas, Stati Uniti, 77550
        • Univ TX Galveston Med Branch
      • Houston, Texas, Stati Uniti, 77030
        • Hermann Hosp / Univ Texas Health Science Ctr
      • Houston, Texas, Stati Uniti, 77030
        • Texas Children's Hosp / Baylor Univ
    • Utah
      • Salt Lake City, Utah, Stati Uniti, 84132
        • Univ of Utah School of Medicine
    • Washington
      • Seattle, Washington, Stati Uniti, 98105
        • Univ of Washington
    • Wisconsin
      • Milwaukee, Wisconsin, Stati Uniti, 53233
        • Great Lakes Hemophilia Foundation

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

12 anni e precedenti (Bambino, Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria

Concurrent Medication:

Required:

  • Aerosolized pentamidine (300 mg every 4 weeks). In the event of physiological intolerance, alternative PCP prophylaxis may be trimethoprim/sulfamethoxazole 1 DS tab per day or dapsone 50 - 100 mg per day.

Allowed:

  • Chronic suppressive treatment for toxoplasmosis, Pneumocystis carinii pneumonia (PCP), cryptococcal meningitis, herpes simplex virus, cytomegalovirus, coccidioidomycosis, and histoplasmosis (absorption of ketoconazole or dapsone may be inhibited if given at the same time as the buffered solution of ddI, and should be taken 2 hours before or 2 hours after taking ddI; oral acidifying agents are not allowed). Isoniazid is permitted only if no acceptable alternative therapy is available. Metronidazole may be used for single courses not to exceed 14 days within consecutive 90 day intervals, the first of which begins at the initiation of the study. Erythropoietin for patients under the relevant treatment IND. Intravenous acyclovir for short courses of therapy.

Patients must:

  • Have documented hematologic intolerance to zidovudine (AZT).
  • Have the diagnosis of AIDS or advanced AIDS related complex (ARC).
  • Have ended treatment for acute Pneumocystis carinii pneumonia (PCP) at least 2 weeks before study entry.

Have previous intolerance on at least two courses of AZT therapy (one of which must have been at daily doses of 500 mg of AZT or less).

  • Be able to provide informed consent (and/or guardian as appropriate).
  • Be available for follow-up for at least 6 months.
  • Have baseline laboratory values as measured within 7 days before initial drug dosing.
  • Allowed:
  • Development of new opportunistic infections during the study - patients remain in the protocol.

Prior Medication:

Required:

  • Prior use and intolerance to zidovudine (AZT).
  • Allowed:
  • Intralesional agents.

Exclusion Criteria

Co-existing Condition:

Patients with the following are excluded:

  • Presence of Kaposi's sarcoma (KS) with known or suspected visceral disease or where KS requires chemotherapy.
  • Active AIDS defining opportunistic infections not specifically allowed.
  • Intractable diarrhea.
  • Stage 2 AIDS-dementia complex.
  • History of intolerance to aerosolized pentamidine.
  • Grade 2 neuropathy, based on the Neuropathy Targeted Symptom Questionnaire, or any moderate abnormality indicative of peripheral neuropathy, particularly impaired sensation of sharp pain, light touch, or vibration in the lower extremities, distal extremity weakness, or distal extremity hyporeflexia.
  • Prior history of acute or chronic pancreatitis.
  • History of seizures within past 2 years or currently requiring anticonvulsants for control.
  • Any other clinical conditions or prior therapy which, in the opinion of the investigator, would make the patient unsuitable for study or unable to comply with the dosing requirements.

Concurrent Medication:

Excluded:

  • Isoniazid (INH).

Patients with the following are excluded:

  • Active AIDS-defining opportunistic infections not specifically allowed.
  • Intractable diarrhea.
  • AIDS-dementia complex = or > stage 2.
  • History of intolerance to aerosolized pentamidine. Grade 2 neuropathy, based on the Neuropathy Targeted Symptom Questionnaire, or any moderate abnormality indicative of peripheral neuropathy, particularly impaired sensation of sharp pain, light touch, or vibration in the lower extremities, distal extremity weakness, or distal extremity hyporeflexia.
  • Prior history of acute or chronic pancreatitis.
  • History of seizures within past 2 years or currently requiring anticonvulsants for control.
  • Any other clinical conditions or prior therapy which, in the opinion of the investigator, would make the patient unsuitable for study or unable to comply with the dosing requirements.
  • Previous participation in any Phase I ddI study.
  • Life expectancy < 6 months.

Prior Medication:

Excluded:

  • Chronic therapy for cytomegalovirus infection with ganciclovir.
  • ddI.
  • d4T.
  • ddC.

Excluded within 2 weeks of study entry:

  • Zidovudine (AZT).

Excluded within 1 month of study entry:

  • Therapy with any other antiretroviral drug or investigational agent not specifically allowed, including interferon and immunomodulating drugs.
  • Ganciclovir.
  • Neurotoxic drugs.

Excluded within 3 months of study entry:

  • Ribavirin.
  • Cytotoxic anticancer therapy.

Prior Treatment:

Excluded within 2 weeks of study randomization:

  • Transfusion.

Active alcohol or drug abuse that is sufficient, in investigator's opinion, to prevent adequate compliance with study therapy.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

Collaboratori

Bristol-Myers Squibb

Investigatori

  • Cattedra di studio: JD Allan
  • Cattedra di studio: J Groopman
  • Cattedra di studio: M Seidlin

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Completamento primario (Effettivo)

1 febbraio 1993

Date di iscrizione allo studio

Primo inviato

2 novembre 1999

Primo inviato che soddisfa i criteri di controllo qualità

30 agosto 2001

Primo Inserito (Stima)

31 agosto 2001

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Stima)

14 marzo 2011

Ultimo aggiornamento inviato che soddisfa i criteri QC

11 marzo 2011

Ultimo verificato

1 ottobre 1994

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • ACTG 118
  • 070V1
  • AI454-007

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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