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Ganciclovir evaluation in AIDS patients with cytomegalovirus retinitis: a European study of treatment patterns and
Objective:
To describe the treatment patterns for intravenous ganciclovir induction and maintenance therapy in AIDS patients with cytomegalovirus (CMV) retinitis in five European countries and to investigate the anticipated impact of oral ganciclovir on resource utilization during maintenance.
Design:
Study was a retrospective analysis based on a prospective randomized clinical trial (AV1034) comparing the efficacy of oral versus intravenous ganciclovir in CMV retinitis maintenance therapy. Resource utilization patterns for ganciclovir induction and maintenance, retinitis progression and management and treatment of adverse events were based on clinical trial data and interviews with local experts involved in treatment of patients with CMV retinitis.
Results:
Oral ganciclovir maintenance was effective, although associated with a faster time to progression, compared to intravenous ganciclovir. There was considerable variation in the treatment patterns for induction with intravenous ganciclovir in the different countries. Most inductions were achieved with a central intravenous line, also used in subsequent intravenous maintenance therapy, usually performed on an outpatient or day care inpatient basis. Intravenous maintenance therapy was identified as a large resource utilization which would decrease considerably with the introduction of oral ganciclovir. In addition, decreased incidence of adverse side effects with oral ganciclovir would also lead to decreased resource use.
Conclusions:
Introduction of oral ganciclovir is expected to lead to significant reduction in resource use and may avoid the need for central line placement. This, and the lower incidence of adverse side effects, normally associated with intravenous ganciclovir, are also expected to lead to improvement in the patient's quality of life.