A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome

Margaret A Fischl, Corette B. Parker, Carla Pettinelli, Michael Wulfsohn, Martin S. Hirsch, Ann C. Collier, Diana Antoniskis, Monto Ho, Douglas D. Richman, Edward Fuchs, Thomas C. Merigan, Richard C. Reichman, Jonathan Gold, Neal Steigbigel, Gifford S. Leoung, Suraiya Rasheed, Anastasios Tsiatis

Research output: Contribution to journalArticlepeer-review

267 Scopus citations

Abstract

Background. The initially tested dose of zidovudine for the treatment of patients with advanced disease caused by the human immunodeficiency virus type 1 (HIV) was 1500 mg. Although this dose is effective, it is associated with substantial toxicity. Methods. To evaluate the efficacy and safety of a reduced dose, we conducted a randomized controlled trial in 524 subjects who had had a first episode of Pneumocystis carinii pneumonia. The subjects were assigned to receive zidovudine in either a dose of 250 mg taken orally every four hours (the standard-treatment group, n = 262) or a dose of 200 mg taken orally every four hours for four weeks and thereafter 100 mg taken every four hours (the low-dose group, n = 262). Results. The median length of follow-up was 25.6 months. At 18 months the estimated survival rates were 52 percent for the standard-treatment group and 63 percent for the low-dose group (P = 0.012 by the log-rank test). At 24 months the estimated survival rates were 27 percent for the standard-treatment group and 34 percent for the low-dose group (P = 0.033). In both groups, 82 percent of the subjects had another opportunistic infection, and the length of time to that infection was similar in the two groups (P = 0.56 by the log-rank test). CD4 T-lymphocyte counts improved transiently in both groups, and serum levels of HIV antigen decreased in the subjects with antigenemia. The hemoglobin level declined to less than 5 mmol per liter (80 g per liter) in 101 subjects in the standard-treatment group and in 77 in the low-dose group (39 vs. 29 percent, P = 0.0009 by the log-rank test). The neutrophil count declined to less than 0.750×109 per liter in 134 subjects in the standard-treatment group and in 96 in the low-dose group (51 vs. 37 percent, P = 0.0001). Conclusions. The reduced daily dose of zidovudine used in this study was at least as effective as the standard dose and was less toxic; however, with the use of a four-week induction period with a high dose followed by low-dose treatment, severe anemia and neutropenia were common complications of treatment with zidovudine.

Original languageEnglish
Pages (from-to)1009-1014
Number of pages6
JournalNew England Journal of Medicine
Volume323
Issue number15
StatePublished - Oct 11 1990

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome'. Together they form a unique fingerprint.

Cite this