Dexamethasone in Cryptococcal Meningitis

NCT ID: NCT00000776

Last Updated: 2021-10-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Completion Date

1996-09-30

Brief Summary

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To evaluate the effect of corticosteroids on reducing elevated intracranial pressure in cryptococcal meningitis. To evaluate the safety of corticosteroids in patients with cryptococcal meningitis and intracranial hypertension.

In AIDS patients with cryptococcal meningitis, a correlation has been found between early death and elevated intracranial pressure. Since dexamethasone has been found to reduce intracranial pressure resulting from other forms of meningitis, it may be of benefit in AIDS patients with cryptococcal meningitis.

Detailed Description

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In AIDS patients with cryptococcal meningitis, a correlation has been found between early death and elevated intracranial pressure. Since dexamethasone has been found to reduce intracranial pressure resulting from other forms of meningitis, it may be of benefit in AIDS patients with cryptococcal meningitis.

Patients are randomized to receive dexamethasone or placebo every 6 hours for 72 hours (days 1 through 3). Additionally, standard antifungal therapy with amphotericin B and flucytosine is given for 2 weeks, followed by fluconazole for 8 weeks. Lumbar punctures will be performed daily on days 1 through 3, on days 7 and 14, and at week 10.

Conditions

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Meningitis, Cryptococcal HIV Infections

Keywords

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AIDS-Related Opportunistic Infections Meningitis Cryptococcosis Dexamethasone Drug Therapy, Combination Fluconazole Flucytosine Acquired Immunodeficiency Syndrome Amphotericin B Brain Diseases

Study Design

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Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Interventions

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Flucytosine

Intervention Type DRUG

Fluconazole

Intervention Type DRUG

Amphotericin B

Intervention Type DRUG

Dexamethasone

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

Concurrent Medication:

Allowed:

* Aerosolized pentamidine or systemic chemoprophylaxis for PCP.
* Preventive therapy for steroid-associated ulcers and any other therapies required to manage steroid toxicity (e.g., insulin).

Patients must have:

* Documented initial episode or relapse of acute cryptococcal meningitis. (NOTE: Patients must be untreated for this episode except for administration of a test dose of 1 g or less amphotericin B.)
* Acute cryptococcal meningitis with cerebrospinal fluid opening pressure \>= 250 mm H2O prior to receipt of antifungal therapy for this episode.
* Documented HIV infection OR a diagnosis of AIDS based on a documented AIDS-defining opportunistic infection.
* Ability to begin therapy within 8 hours after the pre-entry lumbar puncture.
* Consent of parent or guardian if less than 18 years of age.

NOTE:

* Comatose patients eligible provided informed consent can be provided by guardian or next of kin.

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

* Concurrent CNS disease such as another infection or neoplasm that would interfere with assessment of response.
* Prison incarceration.

Concurrent Medication:

Excluded:

* Acetazolamide, mannitol, urea preparations, and other corticosteroids during the first 72 hours of the study.
* Treatment or prophylaxis with other systemic antifungal agents at any time.
* Antiretroviral therapy during the first 72 hours of the study.

Prior Medication:

Excluded within 7 days prior to study entry:

* Corticosteroids, mannitol, urea preparations, acetazolamide, or more than 24 hours of phenytoin.
Minimum Eligible Age

13 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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J Jacobson

Role: STUDY_CHAIR

Locations

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Univ of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status

Georgetown Univ Med Ctr

Washington D.C., District of Columbia, United States

Site Status

Univ of Miami School of Medicine

Miami, Florida, United States

Site Status

Northwestern Univ Med School

Chicago, Illinois, United States

Site Status

Cook County Hosp

Chicago, Illinois, United States

Site Status

SUNY / Health Sciences Ctr at Brooklyn

Brooklyn, New York, United States

Site Status

SUNY / Erie County Med Ctr at Buffalo

Buffalo, New York, United States

Site Status

Beth Israel Med Ctr

New York, New York, United States

Site Status

Mount Sinai Med Ctr

New York, New York, United States

Site Status

Bronx Municipal Hosp Ctr/Jacobi Med Ctr

The Bronx, New York, United States

Site Status

Jack Weiler Hosp / Bronx Municipal Hosp

The Bronx, New York, United States

Site Status

Bronx Veterans Administration / Mount Sinai Hosp

The Bronx, New York, United States

Site Status

Ohio State Univ Hosp Clinic

Columbus, Ohio, United States

Site Status

Univ of Puerto Rico

San Juan, , Puerto Rico

Site Status

Countries

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United States Puerto Rico

Other Identifiers

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11178

Identifier Type: REGISTRY

Identifier Source: secondary_id

ACTG 202

Identifier Type: -

Identifier Source: org_study_id