Comparison of ddI Versus Zidovudine in HIV-Infected Patients

Launched by NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID) · Aug 30, 2001

Nctid: NCT00000979

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Agents", "abbrev"=>"Infe"}, {"name"=>"All Drugs and Chemicals", "abbrev"=>"All"}]}}, "protocolSection"=>{"designModule"=>{"phases"=>["PHASE2"], "studyType"=>"INTERVENTIONAL", "designInfo"=>{"primaryPurpose"=>"TREATMENT"}, "enrollmentInfo"=>{"count"=>1500}}, "statusModule"=>{"overallStatus"=>"COMPLETED", "expandedAccessInfo"=>{"hasExpandedAccess"=>false}, "statusVerifiedDate"=>"2003-01", "lastUpdateSubmitDate"=>"2011-03-11", "studyFirstSubmitDate"=>"1999-11-02", "studyFirstSubmitQcDate"=>"2001-08-30", "lastUpdatePostDateStruct"=>{"date"=>"2011-03-14", "type"=>"ESTIMATED"}, "studyFirstPostDateStruct"=>{"date"=>"2001-08-31", "type"=>"ESTIMATED"}, "primaryCompletionDateStruct"=>{"date"=>"1992-10", "type"=>"ACTUAL"}}, "conditionsModule"=>{"keywords"=>["Didanosine", "Zidovudine"], "conditions"=>["HIV Infections"]}, "referencesModule"=>{"references"=>[{"pmid"=>"7726705", "type"=>"BACKGROUND", "citation"=>"Dolin R, Amato DA, Fischl MA, Pettinelli C, Beltangady M, Liou SH, Brown MJ, Cross AP, Hirsch MS, Hardy WD, et al. Zidovudine compared with didanosine in patients with advanced HIV type 1 infection and little or no previous experience with zidovudine. AIDS Clinical Trials Group. Arch Intern Med. 1995 May 8;155(9):961-74. Erratum In: Arch Intern Med 1995 Nov 13;155(20):2255."}, {"pmid"=>"8028406", "type"=>"BACKGROUND", "citation"=>"Bozzette SA, Hays RD, Berry SH, Kanouse DE. A Perceived Health Index for use in persons with advanced HIV disease: derivation, reliability, and validity. Med Care. 1994 Jul;32(7):716-31. doi: 10.1097/00005650-199407000-00005."}, {"pmid"=>"7712235", "type"=>"BACKGROUND", "citation"=>"Fiscus SA, Heggem-Snow A, Troiani L, Wallmark E, Folds JD, Sheff B, van der Horst CM. Transient high titers of HIV-1 in plasma and progression of disease. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 May 1;9(1):51-7."}, {"pmid"=>"8775802", "type"=>"BACKGROUND", "citation"=>"Schooley RT. Correlation between viral load measurements and outcome in clinical trials of antiviral drugs. AIDS. 1995 Dec;9 Suppl 2:S15-S19."}, {"pmid"=>"7518658", "type"=>"BACKGROUND", "citation"=>"Kozal MJ, Kroodsma K, Winters MA, Shafer RW, Efron B, Katzenstein DA, Merigan TC. Didanosine resistance in HIV-infected patients switched from zidovudine to didanosine monotherapy. Ann Intern Med. 1994 Aug 15;121(4):263-8. doi: 10.7326/0003-4819-121-4-199408150-00005."}, {"pmid"=>"7552481", "type"=>"BACKGROUND", "citation"=>"Fichtenbaum CJ, Clifford DB, Powderly WG. Risk factors for dideoxynucleoside-induced toxic neuropathy in patients with the human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Oct 1;10(2):169-74. doi: 10.1097/00042560-199510020-00009."}, {"pmid"=>"9342254", "type"=>"BACKGROUND", "citation"=>"Spino C, Kahn JO, Dolin R, Phair JP. Predictors of survival in HIV-infected persons with 50 or fewer CD4 cells/mm3. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Aug 15;15(5):346-55. doi: 10.1097/00042560-199708150-00004."}, {"pmid"=>"8229656", "type"=>"RESULT", "citation"=>"Richardson D, Liou SH, Kahn JO. Uric acid and didanosine compliance in AIDS clinical trials: an analysis of AIDS Clinical Trials Group protocols 116A and 116B/117. J Acquir Immune Defic Syndr (1988). 1993 Nov;6(11):1212-23."}, {"pmid"=>"8843205", "type"=>"RESULT", "citation"=>"Welles SL, Jackson JB, Yen-Lieberman B, Demeter L, Japour AJ, Smeaton LM, Johnson VA, Kuritzkes DR, D'Aquila RT, Reichelderfer PA, Richman DD, Reichman R, Fischl M, Dolin R, Coombs RW, Kahn JO, McLaren C, Todd J, Kwok S, Crumpacker CS. Prognostic value of plasma human immunodeficiency virus type 1 (HIV-1) RNA levels in patients with advanced HIV-1 disease and with little or no prior zidovudine therapy. AIDS Clinical Trials Group Protocol 116A/116B/117 Team. J Infect Dis. 1996 Oct;174(4):696-703. doi: 10.1093/infdis/174.4.696."}, {"pmid"=>"8843206", "type"=>"RESULT", "citation"=>"Coombs RW, Welles SL, Hooper C, Reichelderfer PS, D'Aquila RT, Japour AJ, Johnson VA, Kuritzkes DR, Richman DD, Kwok S, Todd J, Jackson JB, DeGruttola V, Crumpacker CS, Kahn J. Association of plasma human immunodeficiency virus type 1 RNA level with risk of clinical progression in patients with advanced infection. AIDS Clinical Trials Group (ACTG) 116B/117 Study Team. ACTG Virology Committee Resistance and HIV-1 RNA Working Groups. J Infect Dis. 1996 Oct;174(4):704-12. doi: 10.1093/infdis/174.4.704."}, {"pmid"=>"15736019", "type"=>"RESULT", "citation"=>"Mildvan D, Spritzler J, Grossberg SE, Fahey JL, Johnston DM, Schock BR, Kagan J. Serum neopterin, an immune activation marker, independently predicts disease progression in advanced HIV-1 infection. Clin Infect Dis. 2005 Mar 15;40(6):853-8. doi: 10.1086/427877. Epub 2005 Feb 18."}]}, "descriptionModule"=>{"briefSummary"=>"To compare the effectiveness and toxicity of didanosine (ddI) and zidovudine (AZT) in patients with AIDS, advanced AIDS-related complex (ARC), or asymptomatic infection with CD4 counts \\< 200 cells/mm3.\n\nAZT 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.", "detailedDescription"=>"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.\n\nAMENDED: 9/28/90 Patients are assigned to one of 2 treatments under a double-blind, randomly allocated, experimental design if their duration of prior AZT therapy is 0 to 16 weeks. (Patients who entered with no more than 16 weeks prior AZT and who were randomized to ddI will continue to be dosed at that level, adjusted for weight, and followed as originally planned.) Patients are assigned to one of 3 treatments as explained prior to this amendment if their duration of prior to AZT therapy is greater than 16 weeks. Original design: Patients are assigned to one of three treatments under a double-blind randomly allocated experimental design. ddI will be administered at two dose levels.\n\nIt is anticipated that patients will be seen as outpatients every 2 weeks for the first 4 weeks of the study and monthly thereafter. This study continues for at least 18 months after the entry of the first subject."}, "eligibilityModule"=>{"sex"=>"ALL", "stdAges"=>["CHILD", "ADULT", "OLDER_ADULT"], "minimumAge"=>"12 years", "healthyVolunteers"=>false, "eligibilityCriteria"=>"Inclusion Criteria\n\nConcurrent Medication:\n\nRequired:\n\n* Aerosolized pentamidine (300 mg every 4 weeks using a Respirgard II nebulizer). In the event of physiological intolerance, alternative prophylaxis may be: Trimethoprim / sulfamethoxazole 1 DS tab per day or dapsone 50 - 100 mg/day.\n\nAllowed:\n\nMaintenance therapy for active AIDS defining opportunistic infections for patients with 9 to 47 weeks' experience with zidovudine (AZT).\n\nTreatment of opportunistic infections with other than sulfonamide containing drugs:\n\n* Pyrimethamine and sulfadiazine or clindamycin for suppression of toxoplasmosis acquired after study entry; fluconazole or amphotericin B for suppression of cryptococcosis or ketoconazole for candidiasis.\n\nIntravenous acyclovir for up to 10 days. Erythropoietin for patients under the relevant treatment IND. Analgesics, antihistamines, antiemetics, antidiarrheal agents for symptomatic therapy for toxicities.\n\nIsoniazid (INH) if no other acceptable therapy is available.\n\nMetronidazole may be used for single courses of therapy not to exceed 14 days within consecutive 90 day intervals. Note:\n\n* Ketoconazole and dapsone should be taken 2 hours before or 2 hours after taking ddI (amendment 5/20/91).\n\nConcurrent Treatment:\n\nAllowed:\n\n* Blood transfusions for hemoglobin toxicity.\n\nPatients must:\n\n* Have a diagnosis of AIDS or advanced AIDS related complex (ARC), or per 8/09/90 amendment, asymptomatic HIV infection with CD4 count = or \\< 200 cells/mm3.\n* Be either naive to zidovudine (AZT) or have taken AZT for = or \\< 48 weeks.\n* Have ended treatment for acute Pneumocystis carinii pneumonia (PCP) at least 2 weeks before study entry. For patients with 2 months or less experience with AZT, PCP infection will be the single and only AIDS-defining infection and must have been within 120 days of study entry. Per amendment, other AIDS-defining conditions are allowed in the 8 weeks prior to study entry (for patients in the AZT stratum).Only one episode of PCP is permitted unless patient has \\> 2 months AZT experience in which case \\> 1 prior episode of PCP infection is allowed.\n* Not have experienced a major intolerance to AZT at doses of at least 500 mg if the patient was on AZT therapy for = or \\< 48 weeks. A major intolerance is defined as recurrent grade 3 or greater toxicity which results in discontinuation of drug.\n\nAllowed:\n\n* Basal cell carcinoma.\n* In situ carcinoma of the cervix.\n* Occasional premature atrial or ventricular contraction.\n* Patients developing new opportunistic infections after study entry will remain on this protocol.\n* Patients whose AIDS-defining condition is Kaposi's sarcoma alone must have CD4 cell counts \\< 300 cells/mm3.\n\nPrior Medication:\n\nAllowed:\n\n* Previous treatment with zidovudine (AZT) up to 48 weeks.\n\nExclusion Criteria\n\nCo-existing Condition:\n\nPatients with the following symptoms or diseases are excluded:\n\n* Kaposi's sarcoma (KS) with evidence of visceral disease or where KS requires chemotherapy; subjects with localized KS having CD4 counts = or \\> 200 cells/mm3.\n* AIDS-dementia complex = or \\> stage 2.\n* Prior history of acute pancreatitis within past 2 years or chronic pancreatitis.\n* Intractable diarrhea.\n* History of seizures within past 6 months or currently requiring anticonvulsants for control.\n* History of past or current heart disease.\n* Presence of a malignancy likely in the investigators opinion to require cytotoxic myelosuppressive chemotherapy during the expected course of this trial.\n\nConcurrent Medication:\n\nExcluded:\n\n* Oral acidifying agents.\n* Neurotoxic drugs. NOTE: If patients require therapy for PCP with IV pentamidine, study mediation is stopped.\n\nPatients with the following are excluded:\n\n* Active AIDS defining events. Maintenance therapy for prior AIDS-defining opportunistic infections is permitted.\n* Intolerance to AZT at doses of 500 mg because of recurrent grade 3 toxicity or greater which resulted in discontinuation of drug.\n* Neoplasms not specifically allowed.\n* Previous enrollment in any study of ddI, ddC or d4T.\n* \\> 48 weeks of AZT therapy.\n* An opportunistic infection not adequately controlled with suppressive therapies allowed in the protocol.\n* Psychological or emotional problems sufficient, in the investigator's opinion, to prevent adequate compliance study therapy.\n* Life expectancy = or \\< 6 months.\n\nPrior Medication:\n\nExcluded:\n\n* Ganciclovir.\n* AZT for = or \\> 48 weeks.\n\nExcluded within 14 days of study entry:\n\n* Erythropoietin (Eprex).\n\nExcluded within 30 days of study entry:\n\n* Anti-HIV therapy other than AZT.\n* Biologic response modifiers.\n* Other investigational drugs.\n* Corticosteroids.\n* Neurotoxic drugs.\n\nExcluded within 90 days of study entry:\n\n* Ribavirin.\n\nPrior Treatment:\n\nExcluded within 14 days of study entry:\n\n* Transfusion.\n\nActive alcohol or drug abuse sufficient, in the investigator's opinion, to prevent adequate compliance with study therapy."}, "identificationModule"=>{"nctId"=>"NCT00000979", "briefTitle"=>"Comparison of ddI Versus Zidovudine in HIV-Infected Patients", "organization"=>{"class"=>"NIH", "fullName"=>"National Institute of Allergy and Infectious Diseases (NIAID)"}, "officialTitle"=>"Comparison of 2',3'-Dideoxyinosine (ddI) (BMY-40900) and Zidovudine in Therapy of Patients With HIV Infection", "orgStudyIdInfo"=>{"id"=>"ACTG 116"}, "secondaryIdInfos"=>[{"id"=>"070V1"}, {"id"=>"ACTG 116-A"}, {"id"=>"ACTG 116-B/117"}, {"id"=>"AI454-008"}]}, "armsInterventionsModule"=>{"interventions"=>[{"name"=>"Zidovudine", "type"=>"DRUG"}, {"name"=>"Didanosine", "type"=>"DRUG"}]}, "contactsLocationsModule"=>{"locations"=>[{"zip"=>"900276016", "city"=>"Los Angeles", "state"=>"California", 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