Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant

被引:201
作者
Musch, DC
Martin, DF
Gordon, JF
Davis, MD
Kuppermann, BD
Heinemann, MH
Campbell, S
Boddice, S
Duker, JS
Naughton, K
McGeary, J
Chong, LP
Walonker, F
Levin, L
Lopez, K
Gomes, A
Davis, JL
Simmons, T
Vandenbrook, R
Fish, RH
Hutchison, C
Ai, E
Luckie, A
Tashayyod, D
Anand, R
Chuang, EL
Lawrence, B
Robinson, MR
Champagne, K
Cantrill, HL
Brallier, A
Freeman, WR
Jarman, C
Wieland, MR
Coverstone, V
Ligh, JK
Hutt, R
Norman, BC
Cristiano, J
Neger, R
Crawford, K
Weinberg, DV
Munana, A
Murphy, FP
Pace, B
Duh, YJ
Gordon, JE
Johnson, PJ
Lee, JA
Pang, CF
机构
[1] CHIRON VIS INC,IRVINE,CA 92718
[2] UNIV MICHIGAN,DEPT OPHTHALMOL,ANN ARBOR,MI
[3] UNIV MICHIGAN,DEPT EPIDEMIOL,ANN ARBOR,MI 48109
[4] EMORY UNIV,DEPT OPHTHALMOL,ATLANTA,GA 30322
[5] CHIRON VIS INC,RES & DEV,CLAREMONT,CA
[6] UNIV WISCONSIN,DEPT OPHTHALMOL,MADISON,WI
[7] UNIV CALIF IRVINE,DEPT OPHTHALMOL,IRVINE,CA 92717
[8] CONTROLLED DELIVERY SYST,WATERTOWN,MA
[9] UNIV WISCONSIN,PUNDUS PHOTOGRAPH READING CTR,MADISON,WI
[10] NEW YORK UNIV MED,NEW YORK,NY
[11] AMER FDN AIDS RES,ROCKVILLE,MD
[12] UNIV PENN,PHILADELPHIA,PA 19104
[13] NEI,BETHESDA,MD 20892
[14] UNIV VIRGINIA,RICHMOND,VA
关键词
D O I
10.1056/NEJM199707103370203
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Sustained-release, intraocular implants that deliver ganciclovir are an alternative method for the treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS). Methods We conducted a randomized study of 188 patients with AIDS and newly diagnosed cytomegalovirus retinitis. The patients were randomly assigned to treatment with an implant delivering 1 mu g of ganciclovir per hour, an implant delivering 2 mu g of ganciclovir per hour, or intravenous ganciclovir. The primary outcome we studied was progression of cytomegalovirus retinitis. Results The median time to progression of retinitis was 221 days with the 1-mu g-per-hour implant (75 eyes), 191 days with the 2-mu g-per-hour implant (71 eyes), and 71 days with ganciclovir administered intravenously (76 eyes; P<0.001). The risk of progression of retinitis was almost three times as great among patients treated with intravenous ganciclovir as among those treated with a ganciclovir implant (risk ratio, 2.8; P<0.001). However, the risk of disease in the initially uninvolved eye was lower with Intravenous ganciclovir than with a ganciclovir implant (risk ratio, 0.5; P=0.19). Patients treated with intravenous ganciclovir were also less likely to have extraocular cytomegalovirus infections (0, vs. 10.3 percent in the two implant groups; P=0.04). Conclusions For the treatment of cytomegalovirus retinitis, the sustained-release ganciclovir implant is more effective than intravenous ganciclovir, but patients treated with a ganciclovir implant alone remain at greater risk for the development of cytomegalovirus disease outside of the treated eye. (C) 1997, Massachusetts Medical Society.
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页码:83 / 90
页数:8
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