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A Controlled Trial Comparing the Efficacy of Aerosolized Pentamidine and Parenteral/Oral Sulfamethoxazole-Trimethoprim in the Treatment of Pneumocystis Carinii Pneumonia in AIDS

Primary Purpose

Pneumonia, Pneumocystis Carinii, HIV Infections

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Pentamidine isethionate
Sulfamethoxazole-Trimethoprim
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 Pneumonia, Pneumocystis Carinii focused on measuring Trimethoprim-Sulfamethoxazole Combination, AIDS-Related Opportunistic Infections, Pneumonia, Pneumocystis carinii, Pentamidine, Infusions, Intravenous, Administration, Inhalation, Aerosols, Acquired Immunodeficiency Syndrome, Sulfamethoxazole-Trimethoprim

Eligibility Criteria

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

Inclusion Criteria Prior Medication: Allowed: Zidovudine (AZT), but must be suspended during study medication. Unequivocal diagnosis of Pneumocystis carinii pneumonia established by morphologic confirmation of three or more typical Pneumocystis carinii organisms in sputum, bronchoalveolar lavage fluid, or lung tissue obtained by transbronchial or open-lung biopsy within 3 days before or after randomization. If morphologic confirmation is not possible prior to therapy, patients may be randomized if the investigator believes there is a high suspicion of PCP based on clinical presentation. If morphologic diagnosis cannot be established within 5 days of randomization, the patient will be withdrawn from study therapy. Resting (A-a) DO2 less than 30 torr on room air at all ACTG sites except San Francisco General Hospital. Non-ACTG sites will enter patients up to a resting (A-a) DO2less than 55 mmHg on room air. Exclusion Criteria Co-existing Condition: Patients with the following are excluded: Dyspnea, cough, bronchospasm, or other reasons causing inability to cooperate with aerosol administration. History of major adverse reaction to pentamidine or sulfonamide-containing preparation defined as: Absolute neutropenia of 750 or less PMN + bands cells/mm3. Thrombocytopenia below 40000 platelets/mm3. Rise in creatinine: To more than 3.0 mg/dl. Liver function abnormalities: SGOT or SGPT greater than 5 x upper limit of normal. Hypoglycemia below 50 mg/dl. Rash: Exfoliative or mucositis. Cough: Unremitting or bronchospasm uncontrolled by bronchodilator preventing more than 50 percent of delivered dose for more than 2 days. Concurrent Medication: Excluded: Other drugs for the treatment or prevention of AIDS or Pneumocystis carinii pneumonia. Zidovudine (AZT). Patients with the following are excluded: Dyspnea, cough, bronchospasm, or other reasons causing inability to cooperate with aerosol administration. History of major adverse reaction to pentamidine or sulfonamide-containing preparation defined as: Absolute neutropenia of 750 or less PMN + bands cells/mm3. Thrombocytopenia lower than 40000 platelets/mm3. Rise in creatinine: To greater than 3.0 mg/dl. Liver function abnormalities: SGOT or SGPT greater than 5 x upper limit of normal. Hypoglycemia less than 50 mg/dl. Rash: Exfoliative or mucositis. Cough: Unremitting or bronchospasm uncontrolled by bronchodilator preventing more than 50 percent of delivered dose for more than 2 days. Prior Medication: Excluded within 14 days of study entry: Systemic steroids higher than adrenal replacement doses. Excluded within 6 weeks of study entry: Another antiprotozoal regimen for this episode, whether therapeutic or prophylactic. Sulfamethoxazole / trimethoprim. Pyrimethamine. Sulfadoxine / pyrimethamine. Pentamidine. Eflornithine.

Sites / Locations

  • Tulane Univ School of Medicine
  • Harvard (Massachusetts Gen Hosp)
  • Bronx Municipal Hosp Ctr/Jacobi Med Ctr
  • Mount Sinai Med Ctr
  • Univ of Rochester Medical Center
  • Univ of North Carolina
  • Holmes Hosp / Univ of Cincinnati Med Ctr
  • Univ Hosp of Cleveland / Case Western Reserve Univ
  • Julio Arroyo

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 2, 1999
Last Updated
October 27, 2021
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT00000715
Brief Title
A Controlled Trial Comparing the Efficacy of Aerosolized Pentamidine and Parenteral/Oral Sulfamethoxazole-Trimethoprim in the Treatment of Pneumocystis Carinii Pneumonia in AIDS
Official Title
A Controlled Trial Comparing the Efficacy of Aerosolized Pentamidine and Parenteral/Oral Trimethoprim-Sulfamethoxazole in the Treatment of Pneumocystis Pneumonia in AIDS
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Completed
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
September 1991 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

5. Study Description

Brief Summary
To compare the safety and effectiveness of drug therapy with aerosolized pentamidine (PEN) with that of conventional therapy, sulfamethoxazole plus trimethoprim (SMX/TMP) in the treatment of Pneumocystis carinii pneumonia (PCP) in patients who have AIDS, are HIV positive, or are at high risk for HIV infection. New treatments are needed for PCP, a common lung infection in patients with AIDS, because many patients treated with the two standard treatments, PEN given by injections and SMX/TMP, have had adverse effects that required a change in treatment. There is also a high relapse rate after the standard treatments. Preliminary experiments in humans suggest that aerosolized PEN is as effective as the standard treatments for PCP, and causes few adverse effects.
Detailed Description
New treatments are needed for PCP, a common lung infection in patients with AIDS, because many patients treated with the two standard treatments, PEN given by injections and SMX/TMP, have had adverse effects that required a change in treatment. There is also a high relapse rate after the standard treatments. Preliminary experiments in humans suggest that aerosolized PEN is as effective as the standard treatments for PCP, and causes few adverse effects. Patients entered in the study are randomly assigned to aerosolized PEN or to intravenous SMX/TMP, for a 21-day trial. SMX/TMP is given 4 times a day and aerosolized PEN once a day. Doses are determined by body size. Patients who receive aerosolized PEN also receive a placebo intravenous injection and patients who receive SMX/TMP also receive a placebo aerosol. Patients are hospitalized at least 5 days. Patients who improve may be discharged after 5 days at the discretion of the attending physician. Discharged patients continue the study with oral SMX/TMP and aerosolized placebo or aerosolized PEN and oral placebo. Patients who fail to respond or who develop severe adverse effects are switched to intravenous PEN or other standard therapy. During the 21-day trial, zidovudine (AZT) may not be used. AZT may be resumed after therapy for the acute PCP episode is completed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pneumonia, Pneumocystis Carinii, HIV Infections
Keywords
Trimethoprim-Sulfamethoxazole Combination, AIDS-Related Opportunistic Infections, Pneumonia, Pneumocystis carinii, Pentamidine, Infusions, Intravenous, Administration, Inhalation, Aerosols, Acquired Immunodeficiency Syndrome, Sulfamethoxazole-Trimethoprim

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Enrollment
240 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Pentamidine isethionate
Intervention Type
Drug
Intervention Name(s)
Sulfamethoxazole-Trimethoprim

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Prior Medication: Allowed: Zidovudine (AZT), but must be suspended during study medication. Unequivocal diagnosis of Pneumocystis carinii pneumonia established by morphologic confirmation of three or more typical Pneumocystis carinii organisms in sputum, bronchoalveolar lavage fluid, or lung tissue obtained by transbronchial or open-lung biopsy within 3 days before or after randomization. If morphologic confirmation is not possible prior to therapy, patients may be randomized if the investigator believes there is a high suspicion of PCP based on clinical presentation. If morphologic diagnosis cannot be established within 5 days of randomization, the patient will be withdrawn from study therapy. Resting (A-a) DO2 less than 30 torr on room air at all ACTG sites except San Francisco General Hospital. Non-ACTG sites will enter patients up to a resting (A-a) DO2less than 55 mmHg on room air. Exclusion Criteria Co-existing Condition: Patients with the following are excluded: Dyspnea, cough, bronchospasm, or other reasons causing inability to cooperate with aerosol administration. History of major adverse reaction to pentamidine or sulfonamide-containing preparation defined as: Absolute neutropenia of 750 or less PMN + bands cells/mm3. Thrombocytopenia below 40000 platelets/mm3. Rise in creatinine: To more than 3.0 mg/dl. Liver function abnormalities: SGOT or SGPT greater than 5 x upper limit of normal. Hypoglycemia below 50 mg/dl. Rash: Exfoliative or mucositis. Cough: Unremitting or bronchospasm uncontrolled by bronchodilator preventing more than 50 percent of delivered dose for more than 2 days. Concurrent Medication: Excluded: Other drugs for the treatment or prevention of AIDS or Pneumocystis carinii pneumonia. Zidovudine (AZT). Patients with the following are excluded: Dyspnea, cough, bronchospasm, or other reasons causing inability to cooperate with aerosol administration. History of major adverse reaction to pentamidine or sulfonamide-containing preparation defined as: Absolute neutropenia of 750 or less PMN + bands cells/mm3. Thrombocytopenia lower than 40000 platelets/mm3. Rise in creatinine: To greater than 3.0 mg/dl. Liver function abnormalities: SGOT or SGPT greater than 5 x upper limit of normal. Hypoglycemia less than 50 mg/dl. Rash: Exfoliative or mucositis. Cough: Unremitting or bronchospasm uncontrolled by bronchodilator preventing more than 50 percent of delivered dose for more than 2 days. Prior Medication: Excluded within 14 days of study entry: Systemic steroids higher than adrenal replacement doses. Excluded within 6 weeks of study entry: Another antiprotozoal regimen for this episode, whether therapeutic or prophylactic. Sulfamethoxazole / trimethoprim. Pyrimethamine. Sulfadoxine / pyrimethamine. Pentamidine. Eflornithine.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
B Montgomery
Official's Role
Study Chair
Facility Information:
Facility Name
Tulane Univ School of Medicine
City
New Orleans
State/Province
Louisiana
ZIP/Postal Code
70112
Country
United States
Facility Name
Harvard (Massachusetts Gen Hosp)
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Bronx Municipal Hosp Ctr/Jacobi Med Ctr
City
Bronx
State/Province
New York
ZIP/Postal Code
10461
Country
United States
Facility Name
Mount Sinai Med Ctr
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Univ of Rochester Medical Center
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States
Facility Name
Univ of North Carolina
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
275997215
Country
United States
Facility Name
Holmes Hosp / Univ of Cincinnati Med Ctr
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
452670405
Country
United States
Facility Name
Univ Hosp of Cleveland / Case Western Reserve Univ
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Julio Arroyo
City
West Columbia
State/Province
South Carolina
ZIP/Postal Code
29169
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
7697233
Citation
Montgomery AB, Feigal DW Jr, Sattler F, Mason GR, Catanzaro A, Edison R, Markowitz N, Johnson E, Ogawa S, Rovzar M, et al. Pentamidine aerosol versus trimethoprim-sulfamethoxazole for Pneumocystis carinii in acquired immune deficiency syndrome. Am J Respir Crit Care Med. 1995 Apr;151(4):1068-74. doi: 10.1164/ajrccm/151.4.1068.
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A Controlled Trial Comparing the Efficacy of Aerosolized Pentamidine and Parenteral/Oral Sulfamethoxazole-Trimethoprim in the Treatment of Pneumocystis Carinii Pneumonia in AIDS

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