Seattle Treatment Education Project (STEP) Perspective, Vol. 5, No. 2 - July 1993 * 127 Broadway E. Ste 200 Seattle, WA 98102
Laury McKean, RN

In another study, full dose combination therapy was used to treat seven cases of severe gastrointestinal CMV, and seven cases of severe retinitis in 13 individuals. The participants were given 90 mg/kg of foscarnet and five mg/kg of ganciclovir twice a day for three weeks. Remission of symptoms and mucosal changes were achieved in five of the seven gastrointestinal cases and scarring was achieved in all seven of the retinitis cases. Reversible renal toxicity was seen in two individuals and hematologic toxicity occurred in eight participants, moderate in seven, severe in one (PO-B08-1344).

A presentation by Dr. Tolpin examined the effectiveness of combination therapy using a human monoclonal anti-CMV antibody (SDZ MSL 109) with either ganciclovir or foscarnet. Seventeen individuals who had gone through induction therapy with ganciclovir (13) or foscarnet (four) were given intravenous infusions of SDZ MSL 109 every two weeks for up to eight doses in addition to their ongoing maintenance therapy with either foscarnet or ganciclovir. SDZ MSL 109 was well tolerated and no exacerbation of the retinitis was seen during the coadministration period. The median time from initiation of induction therapy until the retinitis progressed was 202 days, whereas the median time to progression is generally 60 to 90 days (WS-B11-4).

Another interesting poster provided clinical evidence for the presence of various viral strains of CMV with different drug sensitivities within the same individual as well as within the same eye. Retinal photographs from two individuals showed that while on therapy with either ganciclovir or foscarnet, some lesions responded at the same time that new lesions appeared. The new lesions responded to a switch in therapy to the alternative drug. However, after changing therapy, the lesions which had responded to the initial drug reactivated. When foscarnet and ganciclovir were combined, all active lesions responded (PO-B08-1318).

One poster examined the effectiveness of 5000 centistode silicone oil in the repair of extensive retinal detachments due to CMV retinitis in 26 eyes of 26 individuals. The visual acuities ranged from light perception to 20/400 prior to the operation. Twenty-four of the 26 eyes were successfully reattached. Cataracts developed in three but two have undergone successful cataract surgery. The postoperative visual acuities ranged from 20/400 to 20/30 (PO-Bb08-1317).

Data was presented from a study using anti-CMV hyperimmune human immunoglobulins to prevent CMV disease. This study, which is still in progress, is administering 0.25 ml/kg of anti-CMV human immunoglobulins intramuscularly every four weeks. The study has been in progress for 12 months and none of the 15 participants have experienced CMV disease. Additionally, the investigators have seen increases in CD3 and CD4 lymphocytes, increases in the ratio of CD4/CD8, and activation of natural killer cells (PO-B08-1338).
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