Interferon Gamma-1b Shows Promise as Adjunctive Therapy for Acute Cryptococcal Meningitis

Researchers at the University of Alabama conducted a phase 2, double-blind, placebo-controlled study to evaluate the safety and antifungal activity of adjuvant recombinant interferon (rIFN) gamma-1b in patients with AIDS and acute cryptococcal meningitis.

Patients received 100 or 200 mu g of rIFN gamma-1b or placebo, three times weekly for 10 weeks, plus standard therapy with intravenous amphotericin B, with or without flucytosine, followed by therapy with fluconazole.

End points included conversion of cerebrospinal fluid fungal cultures from positive to negative at 2 weeks, resolution of symptoms, and survival.

Results

Among 75 patients, 2-week culture conversion occurred in 13% of placebo recipients, 36% of rIFN gamma-1b (100 mu g) recipients, and 32% of rIFN gamma-1b (200 mu g) recipients.

There was a trend toward improved combined mycologic and clinical success in rIFN- gamma 1b recipients (26% vs. 8%; P=.078).

Therapy with rIFN gamma-1b was well tolerated, and there was no apparent influence on serial CD4 cell counts and human immunodeficiency virus load measurements.

The authors conclude, “Adjunctive therapy with rIFN gamma-1b holds promise for patients with acute cryptococcal meningitis and warrants further study.”

University of Alabama School of Medicine, Birmingham, Alabama.

06/14/04

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