Table 2.
Comparative trials of curative treatments for toxoplasmosis in immunocompromised patients.
| Clinical setting | Patients (No, type) | Induction regimen | Maintenance regimen | Duration (weeks) | Country | Result | Reference |
|---|---|---|---|---|---|---|---|
| TE | 299 adults HIV+ | P (50 mg/d) + Sz (4 g/d) vs P (50 mg/d) + C (2.4 mg/d) |
P (25 mg/d) + Sz (2 g/d) vs P (25 mg/d) + C (1.2 g/d) |
I: 6 M: Lifelong |
Europe | Endpoint at 6 weeks: No superior treatment More relapses in P/C arm |
(Katlama et al., 1996) |
| TE | 77 adults HIV + | P (50 mg/d) + Sz (60 mg/kg/d) vs T (10 mg/kg/d) + Sx (50 mg/kg/d) |
P (25 mg/d) + Sz (30 mg/kg/d) vs T (5 mg/kg/d) + Sx (25 mg/kg/d) |
I: 4 M: 12 |
Europe (Italy) | No superior treatment More side effects in P/Sz arm |
(Torre et al., 1998) |
| TE | 59 Adults HIV+ | P (200 mg D1; 75 mg/d) + Sz (100 mg/kg/d) vs P (200 mg D1; 75 mg/d) + C (4.8 g/d) |
6 |
USA | Endpoint at 6 weeks No superior treatment |
(Dannemann et al., 1992) | |
| TE | 30 adults HIV + | P (50 mg/d) + Sz (4 g/d) vs P (100 mg/d) + Sz (4 g/d) vs T (10 mg/kg/d) + Sx (50 mg/kg/d) |
6 |
Thailand | Endpoint at 6 weeks More deaths in T/Sx group, but only 10 patients per group |
(Kongsaengdao et al., 2008) | |
| TE | 41 adults HIV+ | P (200 mg D1; 50 mg/d if <60 kg or 75 mg/d if >60 kg) + Sz (4 g/d) vs T (20 mg/kg/d) + Sx (100 mg/kg/d) + C (1.8 g/d) |
P (25 mg/d) + Sz (2 g/d) vs T (10 mg/kg/d) + Sx (50 mg/kg/d) + C (0.9 g/d) |
I: 4–6 M: until CD4 count >200/mm3 |
India | More complete responses and less relapses in T/S + C group | (Goswami et al., 2015) |
| TE | 39 adults HIV+ | A (3 g/d) + P (200 mg D1; 50 mg/d if <60 kg or 75 mg/d if >60 kg) vs A (3 g/d) + Sz (4 g/d if<60 kg or 6 g/d if >60 kg) |
I: 6 M: 42 |
Europe and USA | No superior treatment 75% vs 82% of responses at 6 weeks |
(Chirgwin et al., 2002) | |
| OT | 149, No AIDS but HIV status unknown, 2 IS |
P (100 mg D1; 50 mg/d) + Sz (4 g/d) + CS (60 mg/d) vs C (1.8 g/d) + Sz (4 g/d) + CS (60 mg/d) vs T (320 mg/d) + Sx (1600 mg/d) + CS (60 mg/d) |
4 | Europe (The Netherlands) | P/Sz + CS: reduction of retinal lesions compared with other combinations | (Rothova et al., 1993) | |
TE: Toxoplasmic encephalitis; OT: Ocular toxoplasmosis; HIV: Human immunodeficiency virus; IS: Immunosuppressed patient; P: Pyrimethamine; Sz: Sulfadiazine; C: Clindamycin; T: Trimetoprime; Sx: Sulfamethoxazole; CS: Corticosteroids; A: Atovaquone; vs: versus; I; induction; M: maintenance.