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After Concorde: changes in the initiation of zidovudine (ZDV) therapy in Ontario, Canada.


Natl Conf Hum Retroviruses Relat Infect (1st). 1993 Dec 12-16;:132.

Objective/Description: Results from the Anglo-French MRC/ANRS Concorde trial released in June, 1993, suggest that there is little benefit for asymptomatic patients to start ZDV therapy. The objective of this study is to examine the effect of the Concorde study on the prescribing practices of physicians, by comparing the rates of initiation of ZDV therapy before and after the Concorde results were released. Method: The Government of Ontario funds ZDV therapy for all HIV-infected Ontario residents through the HIV Project Centre. Enrollment records were drawn from the HIV Project Centre's ZDV Registry. Between October, 1990 (ZDV licensure in Canada) and July, 1993, 2,877 patients were enrolled on ZDV. The preliminary post-Concorde time period used was the period from June, 1993 while the pre-Concorde era was the period before this time. Results: In 1993, the mean number of ZDV enrollments dropped by 45.4 percent in the months following the Concorde study compared to the previous months, the post-Concorde enrollments being the lowest since ZDV's licensure. Specifically, the decrease was seen in the number of AIDS, ARC and asymptomatic patients initiating therapy, with percent decreases of 13 percent, 58 percent and 52 percent, respectively. Conclusions: There has been a substantial reduction in the initiation of ZDV therapy following the release of the Concorde study results, suggesting that the physicians treating HIV/AIDS in Ontario have changed their prescribing practice. Surprisingly, the decrease has not been confined to asymptomatics, but has also been seen in symptomatic patients. Additional results will be presented to determine if this trend continues, and to evaluate physician education needs.

Acyclovir/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE CD4 Lymphocyte Count Ditiocarb/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Drug Therapy, Combination Human HIV Infections/*DRUG THERAPY Pneumonia, Pneumocystis carinii/PREVENTION & CONTROL Retrospective Studies ABSTRACT


Information in this article was accurate in December 30, 1995. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.