NOTES FROM ICAAC: Combination Therapy for CMV Retinitis


NOTES FROM ICAAC: Combination Therapy for CMV Retinitis

Being Alive Newsletter; December 1992
Walt Senterfit

Two studies looked at combining ganciclovir and foscarnet for maintenance therapy of CMV retinitis after initial treatment with either drug alone. Both drugs are toxic for many people, though each in a different way, and recurrence or "breakthrough" of symptoms occurs much too frequently. While scientists actively seek new and better drugs against CMV, they reasoned that combining or alternating both of these drugs may take clinical advantage of the synergistic effect found in laboratory studies when the two are used together. Also, a combination may retard the development of resistance to either one and may conceivably lessen the toxicity (by requiring smaller doses of either one).

Preliminary results indicate that both a combination (roughly half the usual dose of each one given every day) or an alternating (full dose of each on alternate days) regimen was free of the kidney toxicity associated with foscarnet about 30% of the time. However, a severe reduction of white blood cells (the major toxicity of ganciclovir) was still relatively high on the combination regimen, but much less so on the alternating one. The effectiveness in preventing relapse seems greater with either of these regimens than with one or the other drug alone, but full results aren't yet available. Overall, it seems likely that using both, particularly in the alternating mode, may be a distinct improvement over one-drug therapy for many people while we await the badly needed better anti-CMV drugs.
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