"Seeing the Way Forward for Treatment of CMV Retinitis"

Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.

"Seeing the Way Forward for Treatment of CMV Retinitis"

Lancet (12/14/91) Vol. 338, No. 8781, P. 1494

Abstract: Trials for foscarnet and ganciclovir were halted because it was assumed that foscarnet was more effective in treating CMV retinitis in AIDS patients, a decision with negative implications to clinical practitioners, write the editors of The Lancet. One group of patients received ganciclovir and the other received foscarnet. Retinitis was suppressed in both groups, but patients receiving foscarnet survived significantly longer than those on ganciclovir. Foscarnet could have suppresed CMV disease elsewhere, preventing or delaying a common cause of death in AIDS patients, or it may have preferentially inhibited a putative co-factor effect of CMV which has been reported to accelerate the rate of progression of HIV infection. It sould be asked therefore why foscarnet is more effective than ganciclovir. This study proves how controlled trials in AIDS patients can identify therapeutic advantages more rapidly than can anecdotal clinical experience. Stopping a trial prematurely and disclosing the results to physicians may be unethical, the editors conclude.

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