A Randomized Controlled Trial of a Reduced Daily Dose of Zidovudine in Patients with the Acquired Immunodeficiency Syndrome
Year: 1990
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: The initially tested dose of zidovudine for the treatment of patients with advanced disease caused by the human immunodeficiency virus type 1 (HIV) was 1500 mg. Although this dose is effective, it is associated with substantial toxicity. METHODS: To evaluate the efficacy and safety of a reduced dose, we conducted a randomized controlled trial in 524 subjects who had had a first episode of Pneumocystis carinii pneumonia. The subjects were assigned to receive zidovudine in either a dose of 250 mg taken orally every four hours (the standard-treatment group, n = 262) or a dose of 200 mg taken orally every four hours for four weeks and thereafter 100 mg taken every four hours (the low-dose group, n = 262). RESULTS: The median length of follow-up was 25.6 months. At 18 months the estimated survival rates were 52 percent for the standard-treatment group and 63 percent for the low-dose group (P = 0.012 by the log-rank test). At 24 months the estimated survival rates were 27 percent for the standard-treatment group and 34 percent for the low-dose group (P = 0.033). In both groups, 82 percent of the subjects had another opportunistic infection, and the length of time to that infection was similar in the two groups (P = 0.56 by the log-rank test). CD4 T-lymphocyte counts improved transiently in both groups, and serum levels of HIV antigen decreased in the subjects with antigenemia. The hemoglobin level declined to less than 5 mmol per liter (80 g per liter) in 101 subjects in the standard-treatment group and in 77 in the low-dose group (39 vs. 29 percent, P = 0.0009 by the log-rank test). The neutrophil count declined to less than 0.750 x 10(9) per liter in 134 subjects in the standard-treatment group and in 96 in the low-dose group (51 vs. 37 percent, P = 0.0001). CONCLUSIONS: The reduced daily dose of zidovudine used in this study was at least as effective as the standard dose and was less toxic; however, with the use of a four-week induction period with a high dose followed by low-dose treatment, severe anemia and neutropenia were common complications of treatment with zidovudine.
Source: New England Journal of Medicine
Authors: Margaret A. Fischl, Corette B. Parker, Carla Pettinelli, Michael Wulfsohn, Martin S. Hirsch, Ann C. Collier, Diana Antoniskis, Monto Ho, Douglas D. Richman, Edward Fuchs, Thomas C. Merigan, Richard C. Reichman, Jonathan Gold, Neal Steigbigel, Gifford S. Leoung, Suraiya Rasheed, Anastasios Tsiatis
Institutions: University of Miami, RTI International, National Institute of Allergy and Infectious Diseases, Harvard University, University of Washington, University of Southern California, University of Pittsburgh, University of California San Diego, Johns Hopkins University, Johns Hopkins Medicine, Johns Hopkins Hospital, Stanford University, University of Rochester Medicine, University of Rochester, Memorial Sloan Kettering Cancer Center, Albert Einstein College of Medicine, Montefiore Medical Center, San Francisco General Hospital, University of California, San Francisco
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2054620412