April 12, 2002
Oral treatment with the drug Valcyte (valganciclovir) appears to be as effective as its cousin ganciclovir, which is administered intravenously, for delaying the progression of cytomegalovirus (CMV) retinitis in AIDS patients. Valcyte is the first orally administered therapy approved for CMV retinitis and is converted to ganciclovir in the body.
CMV is a member of the herpesvirus family that in the immunocompromised patient can affect not only the retina of the eye, but also the colon, where it causes diarrhea, and the esophagus, where it impairs the patient's ability to swallow. Currently, patients newly diagnosed with CMV retinitis are generally treated with injectable therapies, including ganciclovir, which require long infusions that carry the risk of causing the life-threatening condition sepsis.
CMV retinitis remains the leading cause of blindness in AIDS patients, notes lead author Dr. Daniel F. Martin, of Emory University School of Medicine, and colleagues in this week's New England Journal of Medicine (346;15:1119-1126). To compare the effectiveness of the two medications, Martin's team split 160 AIDS patients newly diagnosed with CMV retinitis into two groups. One group received oral doses of Valcyte, while the other was treated with intravenous ganciclovir. A total of seven patients in each group had progression of the disease in the first 4 weeks of treatment. A satisfactory response to treatment was noted in 77 percent of the ganciclovir group, and about 72 percent of those treated with the newer drug. "Orally administered valganciclovir appears to be as effective as intravenous ganciclovir for . . . treatment and is convenient and effective for long-term management of CMV retinitis in patients with AIDS," Martin and colleagues conclude.