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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.

Studieoversikt

Status

Fullført

Forhold

Detaljert beskrivelse

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.

Studietype

Intervensjonell

Registrering

140

Fase

  • Fase 1

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

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

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

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.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Etterforskere

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

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiet fullført (Faktiske)

1. januar 2000

Datoer for studieregistrering

Først innsendt

2. november 1999

Først innsendt som oppfylte QC-kriteriene

30. august 2001

Først lagt ut (Anslag)

31. august 2001

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

1. november 2021

Siste oppdatering sendt inn som oppfylte QC-kriteriene

28. oktober 2021

Sist bekreftet

1. oktober 2021

Mer informasjon

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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