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A Pilot Study of Oral Clindamycin and Pyrimethamine for the Treatment of Toxoplasmic Encephalitis in Patients With AIDS

Primary Purpose

Toxoplasmosis, Cerebral, HIV Infections

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Pyrimethamine
Leucovorin calcium
Clindamycin
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Toxoplasmosis, Cerebral focused on measuring Toxoplasmosis, AIDS-Related Opportunistic Infections, Pyrimethamine, Leucovorin, Drug Evaluation, Drug Therapy, Combination, Encephalitis, Acquired Immunodeficiency Syndrome, Clindamycin

Eligibility Criteria

13 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria Concurrent Medication: Allowed: Erythropoietin. Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia (PCP). Immunoglobulin therapy. Alpha interferon. Patients entering study on isoniazid (INH) may continue INH therapy. Use of corticosteroids is discouraged. If corticosteroids are needed for the management of intracranial hypertension or cranial mass effect, use of dexamethasone is encouraged (4 g orally 4 times daily for 3 days and thereafter tapered over the next 10 to 14 days). Patients are admitted into the study if they have: Laboratory evidence of HIV infection or if they have an undetermined HIV infection status if they belong to a high-risk group for HIV infection. Either a definite or presumptive diagnosis of toxoplasmic encephalitis. Patient or appropriate family member, or legal designee must be able to understand and sign a written informed consent. Allowed: HIV encephalopathy. AMENDED: Allows patients who have relapsed. Patients with a previous diagnosis of toxoplasmic encephalitis based on histopathology or documented neuroradiological response to pyrimethamine and sulfonamides or pyrimethamine and clindamycin and who have relapsed toxoplasmic encephalitis. Relapse must be documented by definite progression of lesions or appearance of new lesions compatible with toxoplasmic encephalitis. Prior Medication: Allowed if liver enzymes stable for 6 weeks prior to study entry: Rifampin. Isoniazid. Exclusion Criteria Co-existing Condition: Patients with the following are excluded: Infections of the central nervous system. Malabsorption syndrome (3 or more loose stools a day for at least 4 weeks associated with an unintentional weight loss of at least 10 percent of body weight). History of sensitivity to the study medication. Malignancies requiring the use of cytotoxic chemotherapy. Coma. Diffuse central white matter lesions. Negative serology for Toxoplasma as performed at the Palo Alto Medical Foundation (unless biopsy is positive). Lymphoma of the central nervous system. Cerebral Kaposi's sarcoma. Hemorrhagic diathesis or active bleeding disorder. Concurrent Medication: Excluded: Erythromycin or other macrolides. Sulfonamides. Immunomodulators. Cytotoxic chemotherapy. Amphotericin. Dapsone. Rifamycins. Ganciclovir. Allopurinol. Antifolates. Azidothymidine and other antiretrovirals and investigational agents not specifically allowed. Folate supplements. Isoniazid (INH) therapy may not be started while on therapy. Concurrent Treatment: Excluded: Lymphocyte replacement. Patients with the following are excluded: Negative HIV antibodies by a federally licensed ELISA (as determined at or after study entry), unless there is documentation of a previously positive HIV culture or p24 antigen. Coma. Diffuse central white matter lesions. Negative serology for Toxoplasma as performed at the Palo Alto Medical Foundation (unless biopsy is positive). Lymphoma of the central nervous system. Cerebral Kaposi's sarcoma. Hemorrhagic diathesis or active bleeding disorder. Unable to take oral medications reliably. Any medical or social condition which, in the opinion of the investigator, would adversely affect either participation and/or compliance in this study. Prior Medication: Excluded: Treatment for toxoplasmic encephalitis.

Sites / Locations

  • USC CRS
  • Stanford CRS
  • Ucsd, Avrc Crs
  • Univ. of Miami AIDS CRS
  • Johns Hopkins Adult AIDS CRS
  • Washington U CRS
  • SUNY - Buffalo, Erie County Medical Ctr.
  • NY Univ. HIV/AIDS CRS
  • Cornell University A2201
  • Memorial Sloan-Kettering Cancer Ctr.
  • Unc Aids Crs
  • Duke Univ. Med. Ctr. Adult CRS
  • Pitt CRS

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 2, 1999
Last Updated
May 17, 2012
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Upjohn, Glaxo Wellcome
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1. Study Identification

Unique Protocol Identification Number
NCT00000674
Brief Title
A Pilot Study of Oral Clindamycin and Pyrimethamine for the Treatment of Toxoplasmic Encephalitis in Patients With AIDS
Official Title
A Pilot Study of Oral Clindamycin and Pyrimethamine for the Treatment of Toxoplasmic Encephalitis in Patients With AIDS
Study Type
Interventional

2. Study Status

Record Verification Date
May 2012
Overall Recruitment Status
Completed
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
August 1992 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Upjohn, Glaxo Wellcome

4. Oversight

5. Study Description

Brief Summary
To collect information on the effectiveness and toxicity of clindamycin plus pyrimethamine and leucovorin calcium for the treatment of acute toxoplasmic encephalitis in adult patients with AIDS. Toxoplasmic encephalitis (encephalitis caused by Toxoplasma gondii) is the most frequent cause of focal central nervous system infection in patients with AIDS. If untreated, the encephalitis is fatal. At present, it is standard practice to give a combination of pyrimethamine and sulfadiazine to treat toxoplasmic encephalitis. The high frequency of sulfonamide-induced toxicity in AIDS patients often makes completion of a full course of therapy difficult. There is some information that high doses of parenteral (such as by injection) clindamycin used with pyrimethamine may be as effective as pyrimethamine plus sulfadiazine in the management of the acute phase of toxoplasmic encephalitis in patients with AIDS. Administration of parenteral clindamycin for prolonged periods of time, however, is costly, requires hospitalization, and is inconvenient for the patient. There is some indication that treatment of AIDS patients with acute toxoplasmic encephalitis with oral clindamycin may be effective. Leucovorin calcium is useful in preventing pyrimethamine-associated bone marrow toxicity.
Detailed Description
Toxoplasmic encephalitis (encephalitis caused by Toxoplasma gondii) is the most frequent cause of focal central nervous system infection in patients with AIDS. If untreated, the encephalitis is fatal. At present, it is standard practice to give a combination of pyrimethamine and sulfadiazine to treat toxoplasmic encephalitis. The high frequency of sulfonamide-induced toxicity in AIDS patients often makes completion of a full course of therapy difficult. There is some information that high doses of parenteral (such as by injection) clindamycin used with pyrimethamine may be as effective as pyrimethamine plus sulfadiazine in the management of the acute phase of toxoplasmic encephalitis in patients with AIDS. Administration of parenteral clindamycin for prolonged periods of time, however, is costly, requires hospitalization, and is inconvenient for the patient. There is some indication that treatment of AIDS patients with acute toxoplasmic encephalitis with oral clindamycin may be effective. Leucovorin calcium is useful in preventing pyrimethamine-associated bone marrow toxicity. Amended: Projected accrual increased to 50 patients. Original design: Patients receive study medications for a total of 6 weeks unless there are intervening events that require the discontinuation of study therapy. Patients are initially treated in the hospital (minimum of 7 days). Patients who are considered responders at day 7 may complete therapy on an outpatient basis. Nonresponders at day 7 may also be managed on an outpatient basis when it is medically appropriate.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Toxoplasmosis, Cerebral, HIV Infections
Keywords
Toxoplasmosis, AIDS-Related Opportunistic Infections, Pyrimethamine, Leucovorin, Drug Evaluation, Drug Therapy, Combination, Encephalitis, Acquired Immunodeficiency Syndrome, Clindamycin

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Masking
None (Open Label)
Enrollment
30 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Pyrimethamine
Intervention Type
Drug
Intervention Name(s)
Leucovorin calcium
Intervention Type
Drug
Intervention Name(s)
Clindamycin

10. Eligibility

Sex
All
Minimum Age & Unit of Time
13 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Concurrent Medication: Allowed: Erythropoietin. Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia (PCP). Immunoglobulin therapy. Alpha interferon. Patients entering study on isoniazid (INH) may continue INH therapy. Use of corticosteroids is discouraged. If corticosteroids are needed for the management of intracranial hypertension or cranial mass effect, use of dexamethasone is encouraged (4 g orally 4 times daily for 3 days and thereafter tapered over the next 10 to 14 days). Patients are admitted into the study if they have: Laboratory evidence of HIV infection or if they have an undetermined HIV infection status if they belong to a high-risk group for HIV infection. Either a definite or presumptive diagnosis of toxoplasmic encephalitis. Patient or appropriate family member, or legal designee must be able to understand and sign a written informed consent. Allowed: HIV encephalopathy. AMENDED: Allows patients who have relapsed. Patients with a previous diagnosis of toxoplasmic encephalitis based on histopathology or documented neuroradiological response to pyrimethamine and sulfonamides or pyrimethamine and clindamycin and who have relapsed toxoplasmic encephalitis. Relapse must be documented by definite progression of lesions or appearance of new lesions compatible with toxoplasmic encephalitis. Prior Medication: Allowed if liver enzymes stable for 6 weeks prior to study entry: Rifampin. Isoniazid. Exclusion Criteria Co-existing Condition: Patients with the following are excluded: Infections of the central nervous system. Malabsorption syndrome (3 or more loose stools a day for at least 4 weeks associated with an unintentional weight loss of at least 10 percent of body weight). History of sensitivity to the study medication. Malignancies requiring the use of cytotoxic chemotherapy. Coma. Diffuse central white matter lesions. Negative serology for Toxoplasma as performed at the Palo Alto Medical Foundation (unless biopsy is positive). Lymphoma of the central nervous system. Cerebral Kaposi's sarcoma. Hemorrhagic diathesis or active bleeding disorder. Concurrent Medication: Excluded: Erythromycin or other macrolides. Sulfonamides. Immunomodulators. Cytotoxic chemotherapy. Amphotericin. Dapsone. Rifamycins. Ganciclovir. Allopurinol. Antifolates. Azidothymidine and other antiretrovirals and investigational agents not specifically allowed. Folate supplements. Isoniazid (INH) therapy may not be started while on therapy. Concurrent Treatment: Excluded: Lymphocyte replacement. Patients with the following are excluded: Negative HIV antibodies by a federally licensed ELISA (as determined at or after study entry), unless there is documentation of a previously positive HIV culture or p24 antigen. Coma. Diffuse central white matter lesions. Negative serology for Toxoplasma as performed at the Palo Alto Medical Foundation (unless biopsy is positive). Lymphoma of the central nervous system. Cerebral Kaposi's sarcoma. Hemorrhagic diathesis or active bleeding disorder. Unable to take oral medications reliably. Any medical or social condition which, in the opinion of the investigator, would adversely affect either participation and/or compliance in this study. Prior Medication: Excluded: Treatment for toxoplasmic encephalitis.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Remington JS
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Luft B
Official's Role
Study Chair
Facility Information:
Facility Name
USC CRS
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Stanford CRS
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Name
Ucsd, Avrc Crs
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
Univ. of Miami AIDS CRS
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Johns Hopkins Adult AIDS CRS
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Washington U CRS
City
St. Louis
State/Province
Missouri
Country
United States
Facility Name
SUNY - Buffalo, Erie County Medical Ctr.
City
Buffalo
State/Province
New York
ZIP/Postal Code
14215
Country
United States
Facility Name
NY Univ. HIV/AIDS CRS
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Facility Name
Cornell University A2201
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Memorial Sloan-Kettering Cancer Ctr.
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Unc Aids Crs
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Duke Univ. Med. Ctr. Adult CRS
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Pitt CRS
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
8366923
Citation
Luft BJ, Hafner R, Korzun AH, Leport C, Antoniskis D, Bosler EM, Bourland DD 3rd, Uttamchandani R, Fuhrer J, Jacobson J, et al. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. Members of the ACTG 077p/ANRS 009 Study Team. N Engl J Med. 1993 Sep 30;329(14):995-1000. doi: 10.1056/NEJM199309303291403.
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A Pilot Study of Oral Clindamycin and Pyrimethamine for the Treatment of Toxoplasmic Encephalitis in Patients With AIDS

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