Studies of the Ocular Complications of AIDS (SOCA)--Foscarnet-Ganciclovir CMV Retinitis Trial (FGCRT)

Foscarnet-Ganciclovir CMV Retinitis Trial

To evaluate the relative safety and efficacy of ganciclovir and foscarnet as initial treatment of patients with cytomegalovirus (CMV) retinitis.

CMV retinitis is the most common intraocular infection in patients with AIDS and is estimated to affect 35 to 40 percent of patients with AIDS. Untreated CMV retinitis is a progressive disorder, the end result of which is total retinal destruction and blindness. The first two drugs approved by the United States Food and Drug Administration (FDA) for the treatment of CMV retinitis were ganciclovir (Cytovene) and foscarnet (Foscavir). At the time of this trial, both ganciclovir and foscarnet were available only as intravenous formulations. Both drugs were given in a similar two-step fashion: an initial 2-week course of high-dose therapy (induction) to control the infection followed by long-term lower dose therapy to prevent relapse (maintenance). The FGCRT compared foscarnet and ganciclovir as initial therapy for CMV retinitis.

The FGCRT was a multicenter, randomized, controlled clinical trial comparing foscarnet and ganciclovir as initial therapy for CMV retinitis. Patients with previously untreated CMV retinitis were randomized to therapy with either intravenous ganciclovir or intravenous foscarnet. The outcome measures of this trial were survival, retinitis progression, loss of visual function (visual acuity and visual field), and morbidity.

Inclusion criteria:

• CMV retinitis in one or both eyes
• At least 1/4 disk are of one CMV lesion photographable
• Diagnosis of AIDS as defined by Center for Disease Control criteria or documented HIV infection
• Age 13 and greater
• Visual acuity ≥ 3/200 in at least one eye diagnosed with CMV retinitis
• Absolute neutrophil count ≥ 1,000 cells/µl
• Platelet ≥ 25,000 cells/µl
• Serum creatinine ≥ 2.0 mg/dl
• Karnofsky score ≥ 60
• Informed consent

Exclusion criteria:

• Previous treatment of CMV retinitis
• Treatment with anti-CMV therapy for an extra-ocular CMV infection currently or in the past 28 days
• Known or suspected allergy to study drugs
• Pregnant or Lactating