Document 2870
 DOCN  M94A2870
 TI    Effect of Concorde Study release on anti-retroviral (AR) use in
       community programs for clinical research on AIDS (CPCRA) trials.
 DT    9412
 AU    Ward TT; Sampson J; Wentworth D; Wallace JA; Portland OR VA Med Ctr.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):206 (abstract no. PB0253). Unique
       Identifier : AIDSLINE ICA10/94369705
 AB    OBJECTIVE: Widespread attention was given to two studies of AR therapy
       at the Berlin International AIDS meetings in mid-June 1993: the Concorde
       Study of AZT Monotherapy (mono) and the ACTG 175 study of combination
       (combo) AZT and ddI. We sought to determine the impact of rapidly
       changing HIV therapeutic information on practice patterns of clinicians.
       METHODS: We retrospectively compared all patients (pts) who were newly
       enrolled in CPCRA trials not before (Jan-Jun 93) vs. after (Jul-Dec 93)
       these meetings to access the trials' impact on actual AR use. RESULTS:
       630 and 640 pts were enrolled in trials before and after the Berlin
       meetings, of whom 69.7 and 65.2%, respectively, received AZT, ddI, or
       ddC mono- or combo therapy. There was a significant (p < 0.001) decrease
       in the proportion of pts who received AZT before (.598) vs. after (.483)
       Berlin, with no significant difference in the proportion of pts
       receiving ddI or ddC. AZT use was significantly decreased both among the
       CD4 < 200 (n = 945, p = 0.006) and 200-500 (n = 268, p < 0.001) strata.
       For those 694 pts who received AR mono, there were significant decreases
       in the frequency of AZT use for all pts with entrance CD counts < 500 (p
       < 0.001), 200-500 (p = 0.017) and < 200 (p = 0.02). The frequency of ddI
       and ddC mono use were not significantly changed. In the 162 pts
       receiving combo AR therapy, there was no change in frequency of use at
       any strata, including the CD4 < 200 stratum (n = 142). DISCUSSION AND
       CONCLUSIONS: A temporal association between the Berlin meetings and AZT
       mono but not combo use was observed, with no observable effect on ddI or
       ddC use. More efficient methods of rapidly disseminating research
       results need to be investigated. The issue of unclear analysis of
       non-peer reviewed research data may unintentionally impact patterns of
       care by HIV clinicians.
 DE    Clinical Trials  Comparative Study  *Congresses
       Didanosine/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE  Drug Therapy,
       Combination  Drug Utilization/STATISTICS & NUMER DATA  Human  HIV
       Infections/*DRUG THERAPY  *Information Services  Multicenter Studies
       *Physician's Practice Patterns  Retrospective Studies
       Zalcitabine/ADMINISTRATION & DOSAGE/THERAPEUTIC USE
       Zidovudine/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).