Ganciclovir Implant Study for Cytomegalovirus Retinitis

This study has been completed.
Sponsor:
Information provided by:
National Eye Institute (NEI)
ClinicalTrials.gov Identifier:
NCT00000118
First received: September 23, 1999
Last updated: September 16, 2009
Last verified: September 2009
  Purpose

To determine the therapeutic efficacy of a sustained-release intraocular drug delivery system for ganciclovir therapy of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS).


Condition Intervention Phase
HIV Infections
Acquired Immunodeficiency Syndrome
Cytomegalovirus Retinitis
Device: Sustained-Release Intraocular Drug Delivery System
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Primary Purpose: Treatment

Resource links provided by NLM:


Further study details as provided by National Eye Institute (NEI):

Study Start Date: October 1992
Study Completion Date: December 1993
Detailed Description:

CMV retinitis occurs in 20 to 30 percent of patients with AIDS and is the leading cause of visual loss in these patients. At present, ganciclovir and foscarnet are the only drugs that have been approved by the U.S. Food and Drug Administration for the treatment of CMV retinitis. The therapeutic regimen for each drug consists of a 2-week induction period followed by daily maintenance intravenous infusions. Unfortunately, CMV retinitis usually progresses despite daily maintenance therapy, and both drugs are associated with significant systemic toxicity that often limits their therapeutic usefulness. As an alternative to intravenous administration, direct intravitreal injections of ganciclovir have been studied and have been shown to be effective in delaying the progression of CMV retinitis. The short half-life of the drug, however, necessitates one to two intraocular injections a week to maintain therapeutic levels. Widespread adoption of this technique has been limited because of the logistical difficulties and inherent risks associated with numerous intravitreal injections.

A drug delivery system capable of continuous delivery of ganciclovir into the vitreous cavity has been developed. The device consists of a 6-mg pellet of ganciclovir that is coated with a series of polymers with variable permeability to ganciclovir. The device is surgically implanted through the pars plana.

Thirty eyes of 26 patients with unilateral non-sight-threatening CMV retinitis were randomly assigned to one of two groups: (1) immediate therapy with a device designed to release ganciclovir into the vitreous cavity a over approximately a 4-month period or (2) deferred treatment. In patients with bilateral non-sight-threatening CMV retinitis, one eye was randomly assigned to receive a ganciclovir implant with the other eye assigned to deferred treatment. (Note: The original trial design included a third randomized arm using a 2 ug/hour device. This arm was dropped for logistical reasons after enrolling two patients.)

Patients assigned to immediate treatment underwent surgery to implant the ganciclovir device within 48 hours of enrollment and baseline photographs. Postoperatively, patients were evaluated the next day, weekly for 2 weeks, and then every 2 weeks until progression of CMV retinitis occurred. At each examination, in both eyes, visual acuity with current correction and best correction was determined using Early Treatment Diabetic Retinopathy Study eye charts; intraocular pressure was determined; evidence of inflammation or cataract was evaluated; and all retinal findings were documented. Any adverse event considered even possibly related to the device or to the implantation procedure was documented. Standardized nine-field fundus photographs were taken at each 2-week visit. The ganciclovir implant was exchanged at 32 weeks or earlier if progression of CMV retinitis occurred.

The primary end point was time to CMV retinitis progression, defined as the time (days) from initiating therapy until the advancement of 750-um over a 750 um front of any border of any lesion was observed. Standardized nine-field photographs were taken at 2-week intervals and analyzed in a masked fashion by the Fundus Photograph Reading Center to determine evidence of CMV retinitis progression.

Secondary end points included time to development of CMV retinitis in the contralateral eye, time to development of visceral CMV, and time to death.

  Eligibility

Genders Eligible for Study:   Both
Criteria

All patients must have had AIDS as defined by the Centers for Disease Control and Prevention and non-sight-threatening CMV retinitis Patients could not have been previously treated with systemic ganciclovir or foscarnet and must not have had evidence of other organ involvement with CMV. Patients must have had an absolute neutrophil count (ANC) greater than 1,000 cells/mL and a platelet count greater than 25,000/mm3

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

No Contacts or Locations Provided
  More Information

Additional Information:
Publications:
ClinicalTrials.gov Identifier: NCT00000118     History of Changes
Other Study ID Numbers: NEI-14
Study First Received: September 23, 1999
Last Updated: September 16, 2009
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Acquired Immunodeficiency Syndrome
HIV Infections
Immunologic Deficiency Syndromes
Retinitis
Cytomegalovirus Retinitis
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Slow Virus Diseases
Immune System Diseases
Retinal Diseases
Eye Diseases
Cytomegalovirus Infections
Herpesviridae Infections
DNA Virus Infections
Eye Infections, Viral
Eye Infections

ClinicalTrials.gov processed this record on September 11, 2014