The Efficacy and Safety of Foscarnet Versus Ganciclovir for Cytomegalovirus Retinitis Associated with AIDS_Chinese Journal of Evidence-Based Medicine

Authors：

HE Qing ¹ , KONG Shuangyan ² , XU Cheng ¹ , WANG Song ¹ ,  ZHAO Liansan ³

1.Donghu Hospital of Shen Zhen City, Shenzheng 5180202.Department of neurology, West China hospital, Sichuan University, Chengdu 610041, China3.Department of infectious diseases, West China hospital, Sichuan University, Chengdu 610041,China;

Corresponding author：

ZHAO Liansan, Email: heqingjoe@163.com

Keywords：

Foscarnet; Ganciclovir; Cytomegalovirus retinitis; Efficacy; Safety; Systematic review

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Objective 　To evaluate the effectiveness and safety of foscarnet and ganciclovir for cytomegalovirus retinitis associated with acquired immune deficiency syndrome (AIDS).
Methods 　We searched MEDLINE (1966 to 2005.12), EMBASE (1974 to Dec.2005), The Cochrane Library (Issue 4,2005), CBM (1978 to Dec.2005), CMCC (1994 to Dec. 2005), CNKI (1994 to Dec. 2005) and VIP (1989 to Dec. 2005). We identified randomized controlled trials of foscarnet versus ganciclovir. Two independent reviewers collected and evaluated details of study populations, interventions, and outcomes using a data extraction form. We conducted meta-analysis of the homoeonomous data.
Result 　Three studies involving 451 patients were included. Meta-analysis showed foscarnet was better than ganciclovir with the following outcomes: mortality (RR=0.84, 95%CI 0.70 to 1.00, P=0.05); male genital ulcers (RR=1.29, 95%CI 0.60 to 2.82, P=0.002). There were no significant differences in ocular symptoms, relapses and other side effects.
Conclusion 　Foscarnet in the treatment of cytomegalovirus retinitis in AIDS patients may be more benefical than ganciclovir with regard to mortality and male genital ulcers, but the supporting evidence is not very b because there are only three trials.

Citation： HE Qing,KONG Shuangyan,XU Cheng,WANG Song,ZHAO Liansan. The Efficacy and Safety of Foscarnet Versus Ganciclovir for Cytomegalovirus Retinitis Associated with AIDS. Chinese Journal of Evidence-Based Medicine, 2006, 06(7): 507-513. doi: Copy

1.	Naraqi S. Cytomegaloviruses. In: Belshe RB. Chief Editor. Textbook of Human Virology. Littleton, MA: PSG Publishing Company. 1984; 887-927.
2.	Gallant JE, Moore RD, Richman DD, et al, and the Zidovudine Epidemiology Study Group. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. J Infect Dis, 1992; 166(6): 1223-1227.
3.	Jabs DA, Green WR, Fox R, et al. Ocular manifestations of acquired immunodeficiency syndrome. Ophthalmology, 1989; 96(7): 1092-1099.
4.	Holland GN, Pepose JS, Pettit TH, et al. Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology, 1983; 90(8): 859-873.
5.	Freeman WR, Lerner CW, Mines JA, et al. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome. Am J Ophthalmol, 1984; 97(2): 133-142.
6.	Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome. Arch Ophthalmol, 1989; 107(1): 75-80.
7.	Palestine AG, Rodrigues MM, Macher AM, et al. Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology, 1984; 91(9): 1092-1099.
8.	Jacobson MA, O’Donnell JJ, Mills J. Foscarnet treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Antimicrob Agents Chemother, 1989; 33(5): 736-741.
9.	Studies of Ocular Complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med, 1992; 326(4): 213-220.
10.	Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. 4. Visual Outcomes. Ophthalmology, 1994; 101(7): 1250-1261.
11.	Studies of ocular complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Morbidity and toxic effects associated with ganciclovir or foscarnet therapy in a randomized cytomegalovirus retinitis trial. Arch Intern Med, 1995; 155(1): 65-74.
12.	The Studies of Ocular Complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group. Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS. Arch Ophthalmol, 1996; 114(1): 23-33.
13.	MoyleG, Gazzard BG. Foscarnet or ganciclovir for treatment of AIDS and CMV retinitis. Am J Med, 1995; 98(3): 319-320.

1. Naraqi S. Cytomegaloviruses. In: Belshe RB. Chief Editor. Textbook of Human Virology. Littleton, MA: PSG Publishing Company. 1984; 887-927.
2. Gallant JE, Moore RD, Richman DD, et al, and the Zidovudine Epidemiology Study Group. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. J Infect Dis, 1992; 166(6): 1223-1227.
3. Jabs DA, Green WR, Fox R, et al. Ocular manifestations of acquired immunodeficiency syndrome. Ophthalmology, 1989; 96(7): 1092-1099.
4. Holland GN, Pepose JS, Pettit TH, et al. Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology, 1983; 90(8): 859-873.
5. Freeman WR, Lerner CW, Mines JA, et al. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome. Am J Ophthalmol, 1984; 97(2): 133-142.
6. Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome. Arch Ophthalmol, 1989; 107(1): 75-80.
7. Palestine AG, Rodrigues MM, Macher AM, et al. Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology, 1984; 91(9): 1092-1099.
8. Jacobson MA, O’Donnell JJ, Mills J. Foscarnet treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Antimicrob Agents Chemother, 1989; 33(5): 736-741.
9. Studies of Ocular Complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med, 1992; 326(4): 213-220.
10. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. 4. Visual Outcomes. Ophthalmology, 1994; 101(7): 1250-1261.
11. Studies of ocular complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Morbidity and toxic effects associated with ganciclovir or foscarnet therapy in a randomized cytomegalovirus retinitis trial. Arch Intern Med, 1995; 155(1): 65-74.
12. The Studies of Ocular Complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group. Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS. Arch Ophthalmol, 1996; 114(1): 23-33.
13. MoyleG, Gazzard BG. Foscarnet or ganciclovir for treatment of AIDS and CMV retinitis. Am J Med, 1995; 98(3): 319-320.

Chinese Journal of Evidence-Based Medicine

The Efficacy and Safety of Foscarnet Versus Ganciclovir for Cytomegalovirus Retinitis Associated with AIDS

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