Hiv Clinical Trial
Official title:
A Randomized Trial of Tamoxifen Combined With Amphotericin B and Fluconazole for Cryptococcal Meningitis
The purpose of this study is to develop initial efficacy, feasibility, and safety data regarding the use of Tamoxifen in combination with amphotericin B and fluconazole in the treatment of cryptococcal meningitis. The results of the study will inform the design and feasibility of a larger study powered to a survival endpoint. The study hypothesis is that adding tamoxifen to standard antifungal therapy increases the rate of clearance of yeast from cerebrospinal fluid. Increased rates of clearance of yeast from cerebrospinal fluid have previously been associated with improved clinical outcomes, including survival and disability.
A randomized, open-label trial with 2 parallel arms: standard antifungal therapy versus
tamoxifen augmented antifungal therapy during the first 2 weeks (induction phase) of
treatment. The study will recruit in two sites in Ho Chi Minh City: the Hospital for Tropical
Diseases (HTD), and Cho Ray Hospital (CRH). 25 patients will be enrolled into the two study
arms (intervention versus control). All anti-fungal administration will be directly observed
by ward staff.
Intervention arm: Induction phase treatment (days 1-14): Tamoxifen will be given orally in a
dose of 300mg/day for the first 14 days following randomization. It will be administered by
nasogastric tube where patients are unconscious. In addition patients will receive
amphotericin 1mg/kg once daily iv and fluconazole 800mg once daily orally. The tamoxifen will
be administered in the morning combined with amphotericin and fluconazole dose.
Control arm: Induction phase treatment (days 1-14): Patients will receive amphotericin
1mg/kg/day combined with fluconazole 800mg once daily for the first 2 weeks. Amphotericin and
fluconazole will be administered simultaneously.
The primary efficacy endpoint will be the rate of clearance of yeast cells from cerebrospinal
fluid (CSF) over the first 2 weeks following randomisation. Patients will be followed for 10
weeks, which is conventional in clinical trials in cryptococcal meningitis. After the first 2
weeks of study treatment, all patients will receive fluconazole 800mg/day for 8 further
weeks, until the study end. At this point, HIV infected patients will be switched to long
term secondary prophylaxis with fluconazole 200mg/day as per standard practice. For HIV
uninfected patients, the decision to continue antifungal treatment, and at which dose, will
be made on a case by case basis by the attending physician in consultation with the patient.
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