A Phase II/III Trial of Rifampin, Ciprofloxacin, Clofazimine, Ethambutol, and Amikacin in the Treatment of Disseminated Mycobacterium Avium Infection in HIV-Infected Individuals.

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID) (NIH)

Overall Status

Completed

CT.gov ID

NCT00000641

Collaborator

(none)

Enrollment

Locations

5.6

Patients Per Site

Study Details

Study Description

Brief Summary

To compare the effectiveness and toxicity of two combination drug treatment programs for the treatment of disseminated Mycobacterium avium infection in HIV seropositive patients. [Per 03/06/92 amendment: to evaluate the efficacy of azithromycin when given in conjunction with either ethambutol or clofazimine as maintenance therapy.] Disseminated M. avium infection is the most common systemic bacterial infection complicating AIDS in the United States. The prognosis of patients with disseminated M. avium is extremely poor, particularly when it follows other opportunistic infections or is associated with anemia. Test tube studies and clinical data indicate that the best treatment program may include clofazimine, ethambutol, a rifamycin derivative, and ciprofloxacin. Test tube and animal studies indicate that amikacin is a bactericidal (bacteria destroying) drug that works better when used with ciprofloxacin. Its role in treatment programs is a key issue because of toxicity and because it must be administered parenterally (by injection or intravenously).

Condition or Disease	Intervention/Treatment	Phase
Mycobacterium Avium-intracellulare Infection HIV Infections	Drug: Ciprofloxacin hydrochloride Drug: Ethambutol hydrochloride Drug: Amikacin sulfate Drug: Azithromycin Drug: Rifampin Drug: Clofazimine	Phase 2

Detailed Description

Disseminated M. avium infection is the most common systemic bacterial infection complicating AIDS in the United States. The prognosis of patients with disseminated M. avium is extremely poor, particularly when it follows other opportunistic infections or is associated with anemia. Test tube studies and clinical data indicate that the best treatment program may include clofazimine, ethambutol, a rifamycin derivative, and ciprofloxacin. Test tube and animal studies indicate that amikacin is a bactericidal (bacteria destroying) drug that works better when used with ciprofloxacin. Its role in treatment programs is a key issue because of toxicity and because it must be administered parenterally (by injection or intravenously).

Patients undergo an initial 2-week observation period (days 1 - 14) during which time baseline evaluations are performed and type and severity of symptoms are monitored. Eligible patients are randomized on day 15 to one of two treatment programs: (1) ciprofloxacin, clofazimine, ethambutol, and rifampin (all taken orally), or (2) the same four drugs plus amikacin. Only patients for whom blood cultures obtained on either day 1 or day 14/15 are positive by week 6 continue on study drugs. Patients receive combination therapy for 24 weeks. Patients may have an indwelling central venous catheter in place for long-term administration of intravenous drug. PER 03/06/92 AMENDMENT: Newly enrolled patients who demonstrate a complete or partial clinical response at the end of study week 10 (8 weeks of drug therapy) discontinue their current regimen and begin maintenance therapy with azithromycin plus either ethambutol or clofazimine for an additional 24 weeks. Patients who do not demonstrate a response at study week 10 are discontinued from all study therapy. Patients enrolled on earlier versions of the protocol who have surpassed study week 16 (14 weeks of drug therapy) continue treatment with their originally assigned regimen through study week 26; those who have not surpassed study week 16 are considered for inclusion in the maintenance phase of the study.

Study Design

Study Type:

Interventional

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase II/III Trial of Rifampin, Ciprofloxacin, Clofazimine, Ethambutol, and Amikacin in the Treatment of Disseminated Mycobacterium Avium Infection in HIV-Infected Individuals.

Actual Study Completion Date :

Dec 1, 1994

Outcome Measures

Primary Outcome Measures

Eligibility Criteria

Criteria

Ages Eligible for Study:

13 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria

Concurrent Medication:

Allowed:

Zidovudine (AZT) and didanosine (ddI). Dideoxycytidine (ddC), EPO, and other experimental therapies granted Treatment IND or Expanded Access status, with the exception of rifabutin.
Concurrent therapies (acute and maintenance) for opportunistic infections not specifically prohibited.

Concurrent Treatment:

Allowed:

Interferon-alfa.

Patients must have the following:

HIV infections or diagnosis of AIDS as per CDC classification.
Mycobacterium avium isolated from blood.
Capability of signing an informed consent, or consent of guardian if < 18 years of age.
Ability and willingness to participate in all components of the study and receive all study therapies.

Prior Medication:

Allowed:

Interferon-alfa.
Single drug prophylaxis for Mycobacterium avium or M. tuberculosis within the previous 4 weeks.

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

Treatment Phase:

Known or suspected allergy to any of the study medications. Severe hearing loss.

Maintenance Phase:

Severe hearing loss. Hypersensitivity to macrolides. Intolerance to ethambutol and clofazimine.

Concurrent Medication:

Excluded:

Acute therapy for other opportunistic infections at time of study entry.
Nephrotoxic agents such as amphotericin B, intravenous vancomycin, or foscarnet during the first 4 weeks of study therapy without specific exemption from one of the protocol chairs. Antacids within 2 hours of ingestion of study drugs.
Immunomodulators (except interferon-alfa) and other antimycobacterial drugs (including quinolones and aminoglycosides).
All experimental therapies (except ddI, ddC, and other experimental agents granted "Treatment IND" or "expanded access" status) will be prohibited (specific exemptions must be obtained from one of the protocol chairs).

Patients with the following are excluded:

Known or suspected allergy to any of the study medications. Cannot take drugs orally.
Severe hearing loss, at the discretion of the investigator.

Prior Medication:

Excluded:

Antimycobacterial drugs (including azithromycin, clarithromycin, rifamycins, quinolones, and aminoglycosides) or immunomodulators (except interferon-alfa) within 4 weeks prior to entry, except single-drug prophylaxis specifically allowed.

History of unreliable drug intake.

Inability to cooperate in the testing procedures.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Harbor-UCLA Med. Ctr. CRS	Torrance	California	United States	90502
2	Indiana Univ. School of Medicine, Infectious Disease Research Clinic	Indianapolis	Indiana	United States	46202
3	St. Louis ConnectCare, Infectious Diseases Clinic	Saint Louis	Missouri	United States
4	Washington U CRS	Saint Louis	Missouri	United States
5	NJ Med. School CRS	Newark	New Jersey	United States	07103
6	NY Univ. HIV/AIDS CRS	New York	New York	United States	10016
7	Beth Israel Med. Ctr. (Mt. Sinai)	New York	New York	United States
8	NYU Med. Ctr., Dept. of Medicine	New York	New York	United States
9	Univ. of Rochester ACTG CRS	Rochester	New York	United States	14642
10	Unc Aids Crs	Chapel Hill	North Carolina	United States	27599
11	Duke Univ. Med. Ctr. Adult CRS	Durham	North Carolina	United States	27710
12	Regional Center for Infectious Disease, Wendover Medical Center CRS	Greensboro	North Carolina	United States
13	Univ. of Cincinnati CRS	Cincinnati	Ohio	United States	45267
14	Case CRS	Cleveland	Ohio	United States	44106
15	Pitt CRS	Pittsburgh	Pennsylvania	United States	15213
16	University of Washington AIDS CRS	Seattle	Washington	United States	98122