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Amphotericin Alone or in Combination With Fluconazole for AIDS-Associated Meningitis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT00145249
Recruitment Status : Completed
First Posted : September 5, 2005
Results First Posted : June 23, 2010
Last Update Posted : May 16, 2012
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)

Study Type: Interventional
Study Design: Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: None (Open Label);   Primary Purpose: Treatment
Condition: Cryptococcal Meningitis
Interventions: Drug: Amphotericin B
Drug: Fluconazole

  Participant Flow

Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
Subjects were screened and enrolled at 10 sites in the US and 5 sites in Thailand.

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
No text entered.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Participant Flow:   Overall Study
    AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800
STARTED   47 [1]   48 [2]   48 [3] 
COMPLETED   36   33   31 
NOT COMPLETED   11   15   17 
[1] 47 subjects randomized; 45 subjects treated
[2] 48 subjects randomized; 47 subjects treated-2 subjects randomized to AmphoB rec'd AmphoB+Fluc400
[3] 48 subjects randomized; 49 treated-3 subjects randomized to AmphoB+Fluc400 rec'd AmphoB+Fluc800



  Baseline Characteristics

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.
Total Total of all reporting groups

Baseline Measures
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800   Total 
Overall Participants Analyzed 
[Units: Participants]
 		 45   47   49   141 
Age 
[Units: Participants]
 		       
<=18 years   0   0   1   1 
Between 18 and 65 years   45   47   47   139 
>=65 years   0   0   1   1 
Age 
[Units: Years]
Mean (Standard Deviation) 		 37.1  (8.47)   36.5  (8.21)   35.9  (9.44)   36.5  (8.69) 
Gender 
[Units: Participants]
 		       
Female   16   15   18   49 
Male   29   32   31   92 
Region of Enrollment 
[Units: Participants]
 		       
United States   14   14   14   42 
Thailand   31   33   35   99 


  Outcome Measures

1.  Primary:   Number of Grade 3-5 Adverse Experiences That Are Definitely or Probably Related to Study Drug   [ Time Frame: Day 100 ]

Measure Type Primary
Measure Title Number of Grade 3-5 Adverse Experiences That Are Definitely or Probably Related to Study Drug
Measure Description

Events are reported by MedDRA Preferred Term.

Grade 3 - Severe. Incapacitating; inability to perform usual activities and daily tasks; significantly affects clinical status; requires therapeutic intervention.

Grade 4 - Life-threatening. AE is life-threatening.

Grade 5 - Death. AE causes death.
Time Frame Day 100  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The Regulatory Safety population includes all subjects who were randomized, who receive at least 1 dose of study drug, and who have any on-study data.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 45   47   49 
Number of Grade 3-5 Adverse Experiences That Are Definitely or Probably Related to Study Drug 
[Units: Events]
 		     
Hypomagnesaemia   2   1   0 
Hypokalaemia   0   0   1 
Anaemia   1   1   0 
Drug intolerance   1   0   0 
Creatinine renal clearance increased   0   0   1 
Psychotic disorder   0   0   1 

No statistical analysis provided for Number of Grade 3-5 Adverse Experiences That Are Definitely or Probably Related to Study Drug



2.  Primary:   Number of Dose-limiting Toxicities Attributed to Treatment Regimens   [ Time Frame: Day 100 ]

Measure Type Primary
Measure Title Number of Dose-limiting Toxicities Attributed to Treatment Regimens
Measure Description

Events are reported by MedDRA Preferred Term.

Dose limiting toxicities include events that resulted in study drug being adjusted, interrupted, or discontinued.
Time Frame Day 100  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The Regulatory Safety population includes all subjects who were randomized, who receive at least 1 dose of study drug, and who have any on-study data.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 45   47   49 
Number of Dose-limiting Toxicities Attributed to Treatment Regimens 
[Units: Events]
 		     
All Events   6   7   14 
Blood creatinine increased   4   1   1 
Creatinine renal clearance decreased   0   1   2 
Creatinine renal clearance increased   0   0   2 
Renal failure   0   2   0 
Renal failure acute   0   1   1 
Azotaemia   0   0   1 
Renal impairment   0   0   1 
Nausea   0   0   1 
Vomiting   0   0   1 
Drug intolerance   1   1   0 
Chills   0   1   0 
Neutropenia   0   0   1 
Hepatitis acute   1   0   0 
Pneumonia   0   0   1 
Dehydration   0   0   1 
Respiratory failure   0   0   1 

No statistical analysis provided for Number of Dose-limiting Toxicities Attributed to Treatment Regimens



3.  Secondary:   Number of Deaths   [ Time Frame: 14, 42, and 70 days ]

Measure Type Secondary
Measure Title Number of Deaths
Measure Description

Number of deaths occurring on study.

Day = Day relative to the first dose of study drug.
Time Frame 14, 42, and 70 days  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The Regulatory Safety Population was used in this analysis, which includes all subjects who were randomized, who received at least 1 dose of study drug, and who have any on-study data.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 45   47   49 
Number of Deaths 
[Units: Subjects]
 		     
All Deaths   10   8   9 
Day 1-14   3   2   1 
Day 15-42   3   2   1 
Day 43-70   1   2   5 
Day >70   3   2   2 

No statistical analysis provided for Number of Deaths



4.  Secondary:   Number of Subjects With Cerebrospinal Fluid (CSF) Culture Conversion at Multiple Time Points   [ Time Frame: Baseline, 14, 42, and 70 days ]

Measure Type Secondary
Measure Title Number of Subjects With Cerebrospinal Fluid (CSF) Culture Conversion at Multiple Time Points
Measure Description Number of subjects that have a negative fungal culture at Baseline, Day 14, Day 42, and Day 70.
Time Frame Baseline, 14, 42, and 70 days  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The modified Intent to Treat (mITT) population includes all subjects who are randomized to a treatment arm and receive any dose of study drug, who provide any outcome data, and who are determined to have met 2 key criteria for inclusion in the primary analysis - diagnosis of culture-proven cryptococcal meningitis and proven HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 46   48   41 
Number of Subjects With Cerebrospinal Fluid (CSF) Culture Conversion at Multiple Time Points 
[Units: Subjects]
 		     
Baseline - Negative   0   0   0 
Day 14 - Negative   20   13   22 
Day 42 - Negative   35   37   36 
Day 70 - Negative   36   39   38 

No statistical analysis provided for Number of Subjects With Cerebrospinal Fluid (CSF) Culture Conversion at Multiple Time Points



5.  Secondary:   Number of Subjects Meeting the Key Efficacy Endpoint of Treatment Success   [ Time Frame: 14, 42, and 70 days ]

Measure Type Secondary
Measure Title Number of Subjects Meeting the Key Efficacy Endpoint of Treatment Success
Measure Description Treatment success is defined as a composite of the 3 mycologic and clinical measures: CSF culture conversion; neurologically stable or improved; and alive
Time Frame 14, 42, and 70 days  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The mITT population includes all subjects who are randomized to a treatment arm and receive any dose of study drug, who provide any outcome data, and who are determined to have met 2 key criteria for inclusion in the primary analysis - diagnosis of culture-proven cryptococcal meningitis and proven HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 46   48   41 
Number of Subjects Meeting the Key Efficacy Endpoint of Treatment Success 
[Units: Subjects]
 		     
Day 14 - Success   19   13   22 
Day 42 - Success   33   35   33 
Day 70 - Success   33   36   32 

No statistical analysis provided for Number of Subjects Meeting the Key Efficacy Endpoint of Treatment Success



6.  Secondary:   Number of Subjects Reporting Immune Reconstitution Inflammatory Syndrome (IRIS)   [ Time Frame: 14, 42, and 70 days ]

Measure Type Secondary
Measure Title Number of Subjects Reporting Immune Reconstitution Inflammatory Syndrome (IRIS)
Measure Description

Number of subjects reporting immune reconstitution inflammatory syndrome (IRIS) following treatment.

Day = Day relative to first dose of study drug
Time Frame 14, 42, and 70 days  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The Regulatory Safety population includes all subjects who were randomized, who receive at least 1 dose of study drug, and who have any on-study data

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 45   47   49 
Number of Subjects Reporting Immune Reconstitution Inflammatory Syndrome (IRIS) 
[Units: Subjects]
 		     
Day 1 through 70   2   0   1 
Day 1-14   0   0   0 
Day 15-42   1   0   0 
Day 43-70   1   0   1 

No statistical analysis provided for Number of Subjects Reporting Immune Reconstitution Inflammatory Syndrome (IRIS)



7.  Secondary:   Mean Days of Hospitalization   [ Time Frame: 7, 14, 42, and 70 days ]

Measure Type Secondary
Measure Title Mean Days of Hospitalization
Measure Description Mean days of hospitalization. Includes days subject was hospitalized prior to study enrollment for current hospital stay.
Time Frame 7, 14, 42, and 70 days  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The mITT population includes all subjects who are randomized to a treatment arm and receive any dose of study drug, who provide any outcome data, and who are determined to have met 2 key criteria for inclusion in the primary analysis - diagnosis of culture-proven cryptococcal meningitis and proven HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 46   48   41 
Mean Days of Hospitalization 
[Units: Days]
Mean (Standard Deviation) 		     
Day 7   8.9  (1.61)   8.8  (2.39)   8.1  (2.53) 
Day 14   15.4  (1.78)   15.1  (3.27)   13.6  (4.37) 
Day 42   16.3  (4.22)   17.4  (5.91)   16.5  (7.03) 
Day 70   16.7  (4.54)   20.1  (11.63)   16.6  (8.24) 

No statistical analysis provided for Mean Days of Hospitalization



8.  Secondary:   Number of Cryptococcal Isolates With Antifungal Susceptibility   [ Time Frame: Days 14 and 70 ]

Measure Type Secondary
Measure Title Number of Cryptococcal Isolates With Antifungal Susceptibility
Measure Description Isolates were collected at days 14 and 70 for assessment of antifungal susceptibility.
Time Frame Days 14 and 70  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The study team has since determined that the assay that was to be utilized did not have sufficient sensitivity/specificity for its intended purpose and therefore these results will not be generated.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 0   0   0 
Number of Cryptococcal Isolates With Antifungal Susceptibility 
[Units: Isolates]
 		        

No statistical analysis provided for Number of Cryptococcal Isolates With Antifungal Susceptibility



9.  Secondary:   Mean Change in Neurological Exam Score From Baseline - Day 14   [ Time Frame: Baseline and Day 14 ]

Measure Type Secondary
Measure Title Mean Change in Neurological Exam Score From Baseline - Day 14
Measure Description Neurological assessment by Mini-mental Status Exam (MMSE). This is collected as a continuous variable with values from 0-30; where lower scores indicate greater impairment.
Time Frame Baseline and Day 14  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The number of subjects tested in the modified Intent to Treat (mITT) population includes all subjects who are randomized to a treatment arm & receive any dose of study drug, who provide any outcome data, & who are determined to have met 2 key criteria for inclusion in the primary analysis: diagnosis of cryptococcal meningitis & HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 40   43   40 
Mean Change in Neurological Exam Score From Baseline - Day 14 
[Units: Scores on a scale]
Mean (Standard Deviation) 		 0.5  (4.07)   2.1  (3.74)   3.5  (6.25) 

No statistical analysis provided for Mean Change in Neurological Exam Score From Baseline - Day 14



10.  Secondary:   Mean Change in Neurological Exam Score From Baseline - Day 42   [ Time Frame: Baseline and Day 42 ]

Measure Type Secondary
Measure Title Mean Change in Neurological Exam Score From Baseline - Day 42
Measure Description Neurological assessment by Mini-mental Status Exam (MMSE). This is collected as a continuous variable with values from 0-30; where lower scores indicate greater impairment.
Time Frame Baseline and Day 42  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The number of subjects tested in the modified Intent to Treat (mITT) population includes all subjects who are randomized to a treatment arm & receive any dose of study drug, who provide any outcome data, & who are determined to have met 2 key criteria for inclusion in the primary analysis: diagnosis of cryptococcal meningitis & HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 37   39   37 
Mean Change in Neurological Exam Score From Baseline - Day 42 
[Units: Scores on a scale]
Mean (Standard Deviation) 		 1.6  (2.58)   1.8  (4.42)   3.3  (7.9) 

No statistical analysis provided for Mean Change in Neurological Exam Score From Baseline - Day 42



11.  Secondary:   Mean Change in Neurological Exam Score From Baseline - Day 70   [ Time Frame: Baseline and Day 70 ]

Measure Type Secondary
Measure Title Mean Change in Neurological Exam Score From Baseline - Day 70
Measure Description Neurological assessment by Mini-mental Status Exam (MMSE). This is collected as a continuous variable with values from 0-30; where lower scores indicate greater impairment.
Time Frame Baseline and Day 70  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The number of subjects tested in the modified Intent to Treat (mITT) population includes all subjects who are randomized to a treatment arm & receive any dose of study drug, who provide any outcome data, & who are determined to have met 2 key criteria for inclusion in the primary analysis: diagnosis of cryptococcal meningitis & HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 37   34   30 
Mean Change in Neurological Exam Score From Baseline - Day 70 
[Units: Scores on a scale]
Mean (Standard Deviation) 		 1.5  (3.28)   2.2  (3.58)   4.2  (6.84) 

No statistical analysis provided for Mean Change in Neurological Exam Score From Baseline - Day 70



12.  Secondary:   Mean Change in Neurological Exam Score From Baseline - Day 168   [ Time Frame: Baseline and Day 168 ]

Measure Type Secondary
Measure Title Mean Change in Neurological Exam Score From Baseline - Day 168
Measure Description Neurological assessment by Mini-mental Status Exam (MMSE). This is collected as a continuous variable with values from 0-30; where lower scores indicate greater impairment.
Time Frame Baseline and Day 168  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The number of subjects tested in the modified Intent to Treat (mITT) population includes all subjects who are randomized to a treatment arm & receive any dose of study drug, who provide any outcome data, & who are determined to have met 2 key criteria for inclusion in the primary analysis: diagnosis of cryptococcal meningitis & HIV infection.

Reporting Groups
  Description
AmphoB Standard Amphotericin B 0.7 mg/kg for 14 day followed by fluconazole 400 mg daily for 8 weeks. For subjects in the standard therapy arm whose Amphotericin B dose is continued beyond 14 days, fluconazole initiation will be delayed.
AmphoB+Fluc400 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 400 mg/day for the first 14 days, then the randomized dose of fluconazole at 400 mg/day respectively for an additional 8 weeks.
AmphoB + Fluc800 Amphotericin B 0.7 mg/kg and the randomized dose of fluconazole at 800 mg/day for the first 14 days, then the randomized dose of fluconazole at 800 mg/day respectively for an additional 8 weeks.

Measured Values
   AmphoB Standard   AmphoB+Fluc400   AmphoB + Fluc800 
Participants Analyzed 
[Units: Participants]
 		 33   27   28 
Mean Change in Neurological Exam Score From Baseline - Day 168 
[Units: Scores on a scale]
Mean (Standard Deviation) 		 2.0  (2.28)   2.8  (3.92)   4.4  (7.58) 

No statistical analysis provided for Mean Change in Neurological Exam Score From Baseline - Day 168




  Serious Adverse Events


  Other Adverse Events


  Limitations and Caveats

Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
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