Document 0230
 DOCN  M9650230
 TI    The use of oral ganciclovir in the treatment of cytomegalovirus
       retinitis in patients with AIDS.
 DT    9605
 AU    Ward-Able C; Phillips P; Tsoukas CM; BioMed Business Unit of Hoffmann-La
       Roche (Canada), Mississauga,; Ont.
 SO    Can Med Assoc J. 1996 Feb 1;154(3):363-8. Unique Identifier : AIDSLINE
       MED/96164734
 AB    OBJECTIVE: To recommend the appropriate use of oral ganciclovir as an
       alternative to intravenous (i.v.) maintenance therapy for
       cytomegalovirus (CMV) retinitis in patients with AIDS. OPTIONS: i.v.
       infusion of ganciclovir and foscarnet have been the only approved
       choices for maintenance therapy until the introduction of oral
       ganciclovir. OUTCOMES: Ease of administering maintenance therapy and
       improved quality of life for patients with AIDS. VALUES: The medical
       advisory group comprised physicians treating patients with AIDS therapy.
       Ease of administration of maintenance therapy and quality of patients'
       lives were considered important. BENEFITS, HARMS AND COSTS: Oral
       ganciclovir is a safe and convenient alternative to i.v. maintenance
       therapy for patients with CMV retinitis. However, its low
       bio-availability precludes its use for induction therapy and
       necessitates careful monitoring for compliance. Compared with i.v.
       administration of ganciclovir, oral maintenance therapy is cost
       effective. EVIDENCE: Evidence for the guidelines was gathered from data
       presented at a symposium on CMV retinitis and oral ganciclovir, clinical
       trials of oral ganciclovir and input from a visiting expert. It was
       presented at a meeting of the advisory board whose members are involved
       in the care of patients with AIDS and the management of CMV retinitis.
       The guidelines were approved by each member of the advisory board.
       RECOMMENDATIONS: Diagnosis, treatment and follow-up of CMV retinitis
       should always be in consultation with an ophthalmologist who is
       experienced in treating this disease. The patient should be fully
       informed about the limitations of the oral form of ganciclovir; he or
       she should be involved in decision making and carefully monitored. Oral
       ganciclovir should not be used for induction therapy or for maintenance
       therapy in high-risk patients. VALIDATION: Similar guidelines have been
       produced in England where the drug has been available since January
       1995. SPONSOR: The deliberations of the advisory board and the
       preparation of this report were funded through an educational grant from
       Hoffmann-La Roche (Canada).
 DE    Administration, Oral  AIDS-Related Opportunistic Infections/*DRUG
       THERAPY  Cytomegalovirus Retinitis/*DRUG THERAPY
       Ganciclovir/*THERAPEUTIC USE  Human  Practice Guidelines  Support,
       Non-U.S. Gov't  JOURNAL ARTICLE

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