Trimetrexate with leucovorin versus trimethoprim-sulfamethoxazole for moderate to severe episodes of Pneumocystis carinii pneumonia in patients with AIDS: a prospective, controlled multicenter investigation of the AIDS Clinical Trials Group Protocol 029/031
| Autor: | S. Sacks Henry, Robert P. Baughman, William G. Powderly, Gocke David, Charles van der Horst, Judith Feinberg, John M. Leedom, Brent Shelton, S. Milton, Walter Weiss, Lederman Michael, Roy T. Steigbigel, Larry Nichols, Henry Masur, Claire Hughlett, Fred R. Sattler, Peter T. Frame, Reichman Richard, Eyster Elaine, Roger J. Davis, Bisher Akil, John H. Black, Phair John, Beck Keith |
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| Rok vydání: | 1994 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Sulfamethoxazole medicine.medical_treatment Leucovorin Gastroenterology Trimethoprim chemistry.chemical_compound Clinical Protocols Double-Blind Method Internal medicine medicine Immunology and Allergy Humans Multicenter Studies as Topic heterocyclic compounds Cumulative incidence Prospective Studies Adverse effect Child Chemotherapy AIDS-Related Opportunistic Infections business.industry Pneumonia Pneumocystis Middle Aged bacterial infections and mycoses medicine.disease Surgery Pneumonia Infectious Diseases Trimetrexate Treatment Outcome chemistry Pneumocystis carinii Antifolate Drug Therapy Combination Female business medicine.drug |
| Zdroj: | The Journal of infectious diseases. 170(1) |
| ISSN: | 0022-1899 |
| Popis: | Trimetrexate is a powerful inhibitor of the dihydrofolate reductase of Pneumocystis carinii. AIDS patients (n = 215) with moderate to severe P. carinii pneumonia were enrolled in a double-blind study of trimetrexate plus leucovorin versus trimethoprim-sulfamethoxazole (TMP-SMZ) for 21 days. By study day 10, study therapy failed because of lack of efficacy in 16% of patients assigned to TMP-SMZ and 27% assigned to trimetrexate (P = .064), and the PAO2-PaO2 improved significantly faster with TMP-SMZ. By study day 21, failure rates were 20% with TMP-SMZ and 38% with trimetrexate (P = .008), with respective mortality rates of 12% and 20% (P = .088). By study day 49, the difference in mortality (16% vs. 31%) was significant (P = .028). The cumulative incidence of serious and treatment-terminating adverse events including hematologic toxicities was less with trimetrexate (P < .001). Thus, trimetrexate plus leucovorin was effective, albeit inferior to TMP-SMZ, for moderately severe P. carinii pneumonia but was better tolerated than TMP-SMZ. |
| Databáze: | OpenAIRE |
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