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N Engl J Med. 2009 Oct 15;361(16):1548-59. doi: 10.1056/NEJMoa0903175.

Interleukin-2 therapy in patients with HIV infection.

Collaborators (949)

Aagaard B, Aragon E, Arnaiz J, Borup L, Clotet B, Dragsted U, Fau A, Gey D, Grarup J, Hengge U, Herrero P, Jansson P, Jensen B, Jensen K, Juncher H, Lopez P, Lundgren J, Matthews C, Mollerup D, Pearson M, Phillips A, Reilev S, Tillmann K, Varea S, Angus B, Babiker A, Cordwell B, Darbyshire J, Dodds W, Fleck S, Horton J, Hudson F, Moraes Y, Pacciarini F, Palfreeman A, Paton N, Smith N, van Hooff F, Bebchuk J, Collins G, Denning E, DuChene A, Fosdick L, Harrison M, Herman-Lamin K, Krum E, Larson G, Neaton J, Nelson R, Quan K, Quan S, Schultz T, Thompson G, Wentworth D, Wyman N, Carey C, Chan F, Cooper D, Cordwell B, Courtney-Rodgers D, Drummond F, Emery S, Harrod M, Jacoby S, Kearney L, Law M, Lin E, Pett S, Robson R, Seneviratne N, Stewart M, Watts E, Finley E, Gordin F, Sánchez A, Standridge B, Vjecha M, Belloso W, Davey R, Duprez D, Gatell J, Hoy J, Lifson A, Pederson C, Perez G, Price R, Prineas R, Rhame F, Sampson J, Worley J, Modlin J, Beral V, Chaisson R, Fleming T, Hill C, Kim K, Murray B, Pick B, Seligmann M, Weller I, Cahill K, Fox L, Luzar M, Martinez A, McNay L, Pierson J, Tierney J, Vogel S, Costas V, Eckstrand J, Brown S, Abusamra L, Angel E, Aquilia S, Belloso W, Benetucci J, Bittar V, Bogdanowicz E, Cahn P, Casiro A, Contarelli J, Corral J, Daciuk L, David D, Dobrzanski W, Duran A, Ebenrstejin J, Ferrari I, Fridman D, Galache V, Guaragna G, Ivalo S, Krolewiecki A, Lanusse I, Laplume H, Lasala M, Lattes R, Lazovski J, Lopardo G, Losso M, Lourtau L, Lupo S, Maranzana A, Marson C, Massera L, Moscatello G, Olivia S, Otegui I, Palacios L, Parlante A, Salomon H, Sanchez M, Somenzini C, Suarez C, Tocci M, Toibaro J, Zala C, Agrawal S, Ambrose P, Anderson C, Anderson J, Baker D, Beileiter K, Blavius K, Bloch M, Boyle M, Bradford D, Britton P, Brown P, Busic T, Cain A, Carrall L, Carson S, Chenoweth I, Chuah J, Clark F, Clemons J, Clezy K, Cooper D, Cortissos P, Cunningham N, Curry M, Daly L, D'Arcy-Evans C, Del Rosario R, Dinning S, Dobson P, Donohue W, Doong N, Downs C, Edwards E, Edwards S, Egan C, Ferguson W, Finlayson R, Forsdyke C, Foy L, Franic T, Frater A, French M, Gleeson D, Gold J, Habel P, Haig K, Hardy S, Holland R, Hoy J, Hudson J, Hutchison R, Hyland N, James R, Johnston C, Kelly M, King M, Kunkel K, Lau H, Leamy J, Lester D, Leung J, Lohmeyer A, Lowe K, MacRae K, Magness C, Martinez O, Maruszak H, Medland N, Miller S, Murray J, Negus P, Newman R, Ngieng M, Nowlan C, Oddy J, Orford N, Orth D, Patching J, Plummer M, Price S, Primrose R, Prone I, Ree H, Remington C, Richardson R, Robinson S, Rogers G, Roney J, Roth N, Russell D, Ryan S, Sarangapany J, Schmidt T, Schneider K, Shields C, Silberberg C, Shaw D, Skett J, Smith D, Soo TM, Sowden D, Street A, Tee BK, Thomson JI, Topaz S, Vale R, Villella C, Walker A, Watson A, Wendt N, Williams L, Youds D, Aichelburg A, Cichon P, Gemeinhart B, Rieger A, Schmied B, Touzeau-Romer V, Vetter N, Colebunders R, Clumeck N, DeRoo A, Kabeya K, O'Doherty E, de Wit S, Amorim Cde S, Basso C, Flint S, Kallas E, Levi G, Lewi D, Pereira L Jr, da Silva M, Souza T, Toscano A, Angel J, Arsenault M, Bast M, Beckthold B, Bouchard P, Chabot I, Clarke R, Cohen J, Coté P, Ellis M, Gagne C, Gill J, Houde M, Johnston B, Jubinville N, Kato C, Lamoureux N, Larson G, Latendre-Paquette J, Lindemulder A, McNeil A, McFarland N, Montaner J, Morrisseau C, O'Neill R, Page G, Piche A, Pongracz B, Preziosi H, Puri L, Rachlis A, Ralph E, Raymond I, Rouleau D, Routy JP, Sandre R, Seddon T, Shafran S, Sikora C, Smaill F, Stromberg D, Trottier S, Walmsley S, Weiss K, Williams K, Zarowny D, Baadegaard B, Andersen AB, Boedker K, Collins P, Gerstoft J, Jensen L, Moller H, Andersen PL, Loftheim I, Mathiesen L, Nielsen H, Obel N, Pedersen C, Petersen D, Jensen LP, Black FT, Aboulker JP, Aouba A, Bensalem M, Berthe H, Blanc C, Bloch M, Bornarel D, Bouchaud O, Boue F, Bouvet E, Brancon C, Breaud S, Brosseau D, Brunet A, Capitant C, Ceppi C, Chakvetadze C, Cheneau C, Chennebault JM, De Truchis P, Delavalle AM, Delfraissy JF, Dellamonica P, Delavalle AM, Dumont C, Edeb N, Fabre G, Ferrando S, Foltzer A, Foubert V, Gastaut JA, Gerbe J, Girard PM, Goujard C, Hoen B, Honore P, Hue H, Hynh T, Jung C, Kahi S, Katlama C, Lang JM, Le Baut V, Lefebvre B, Leturque N, Lévy Y, Loison J, Maddi G, Maignan A, Majerholc C, de Boever C, Meynard JL, Michelet C, Michon C, Mole M, Netzer E, Pialoux G, Poizot-Martin I, Raffi F, Ratajczak M, Ravaux I, Reynes J, Salmon-Ceron D, Sebire M, Simon A, Tegna L, Tisne-Dessus D, Tramoni C, Viard JP, Vidal M, Viet-Peaucelle C, Weiss L, Zeng A, Zucman D, Adam A, Arastéh K, Behrens G, Bergmann F, Bickel M, Bittner D, Bogner J, Brockmeyer N, Darrelmann N, Deja M, Doerler M, Esser S, Faetkenheuer G, Fenske S, Gajetzki S, Gey D, Goebel F, Gorriahn D, Harrer E, Harrer T, Hartl H, Hartmann M, Heesch S, Jakob W, Jäger H, Klinker H, Kremer G, Ludwig C, Mantzsch K, Mauss S, Meurer A, Niedermeier A, Pittack N, Plettenberg A, Potthoff A, Probst M, Rittweger M, Rockstroh J, Ross B, Rotty J, Rund E, Ruzicka T, Schmidt RT, Schmutz G, Schnaitmann E, Schuster D, Sehr T, Spaeth B, Staszewski S, Stellbrink HJ, Stephan C, Stockey T, Stoehr A, Tillmann K, Trein A, Vaeth T, Vogel M, Wasmuth J, Wengenroth C, Winzer R, Wolf E, Mulcahy F, Reidy DI, Cohen Y, Drora G, Eliezer I, Godo O, Kedem E, Magen E, Mamorsky M, Pollack S, Sthoeger Z, Vered H, Yust I, Aiuti F, Bechi M, Bergamasco A, Bertelli D, Bruno R, Butini L, Cagliuso M, Carosi G, Casari S, Chrysoula V, Cologni G, Conti V, Costantini A, Corpolongo A, D'Offizi G, Gaiottino F, Di Pietro M, Esposito R, Filice G, Francesco M, Gianelli E, Graziella C, Magenta L, Martellotta F, Maserati R, Mazzotta F, Murdaca G, Nardini G, Nozza S, Puppo F, Pogliaghi M, Ripamonti D, Ronchetti C, Rusconi S, Rusconi V, Sacchi P, Silvia N, Suter F, Tambussi G, Uglietti A, Vechi M, Vergani B, Vichi F, Vitiello P, Iwamoto A, Kikuchi Y, Miyazaki N, Mori M, Nakamura T, Odawara T, Oka S, Shirasaka T, Tabata M, Takano M, Ueta C, Watanabe D, Yamamoto Y, Erradey I, Himmich H, El Filali KM, Blok W, van Boxtel R, Doevelaar KB, van Eeden A, Grijsen M, Groot M, Juttmann J, Kuipers M, Ligthart S, van der Meulen P, Lange J, Langebeek N, Ligthart S, Reiss P, Richter C, Schoemaker M, Schrijnders-Gudde L, Septer-Bijleveld E, Sprenger H, Vermeulen J, ten Kate R, van de Ven B, Bruun J, Kvale D, Maeland A, Bakowska E, Beniowski M, Boron-Kaczmarska A, Gasiorowski J, Horban A, Inglot M, Knysz B, Mularska E, Parczewski M, Pynka M, Rymer W, Szymczak A, Aldir M, Antunes F, Baptista C, Vera Jda C, Doroana M, Mansinho K, dos Santos CR, Valadas E, Pinto IV, Chia E, Foo E, Karim F, Lim PL, Panchalingam A, Paton N, Quek A, Alcázar-Caballero R, Aragon E, Arnaiz J, Arrizabalaga J, de Barron X, Blanco F, Bouza E, Bravo I, Calvo S, Carbonero L, Carpena I, Castro M, Clotet B, Cortes L, del Toro M, Domingo P, Elias M, Espinosa J, Estrada V, Fernandez-Cruz E, Fernández P, Freud H, Fuster M, Garcia A, Garcia G, Garrido R, Gatell J, Gijón P, Gonzalez-García J, Gil I, González A, González-Lahoz J, López Grosso P, Gutierrez M, Guzmán E, Iribarren J, Jiménez M, Jou A, Juega J, Lopez J, Lopez P, Lozano F, Martín-Carbonero L, Mata R, Mateo G, Menasalvas A, Mirelles C, de Miguel Prieto J, Montes M, Moreno A, Moreno J, Moreno V, Muñoz R, Ocampo A, Ortega E, Ortiz L, Padilla B, Parras A, Paster A, Pedreira J, Peña J, Perea R, Portas B, Puig J, Pulido F, Rebollar M, de Rivera J, Roca V, Rodríguez- Arrondo F, Rubio R, Santos J, Sanz J, Sebastian G, Segovia M, Soriano V, Tamargo L, Varea S, Viciana P, von Wichmann M, Bratt G, Hollander A, Pehrson PO, Petz I, Sandstrom E, Sönnerborg A, Bernasconi E, Gurtner V, Ampunpong U, Auchieng C, Bowonwatanuwong C, Chanchai P, Chetchotisakd P, Chuenyan T, Duncombe C, Horsakulthai M, Kantipong P, Laohajinda K, Phanuphak P, Pongsurachet V, Pradapmook S, Ruxruntham K, Seekaew S, Sonjai A, Suwanagool S, Techasathit W, Ubolyam S, Wankoon J, Alexander I, Dockrell D, Easterbrook P, Edwards B, Evans E, Fisher M, Fox R, Gazzard B, Gilleran G, Hand J, Heald L, Higgs C, Jeakumar S, Jendrulek I, Johnson M, Johnson S, Karim F, Kinghorn G, Kuldanek K, Leen C, Maw R, McKernan S, McLean L, Morris S, Murphy M, O'Farrell S, Ong E, Peters B, Stroud C, Wansbrough-Jones M, Weber J, White D, Williams I, Wiselka M, Yee T, Adams S, Allegra D, Andrews L, Aneja B, Anstead G, Arduino R, Artz R, Bailowitz J, Banks S, Baxter J, Baum J, Benator D, Black D, Boh D, Bonam T, Brito M, Brockelman J, Brown S, Bruzzese V, Burnside A Jr, Cafaro V, Casey K, Cason L, Childress G, Clark CI, Clifford D, Climo M, Cohn D, Couey P, Cuervo H, Davey R Jr, Deeks S, Dennis M, Diaz-Linares M, Dickerson D, Diez M, Di Puppo J, Dodson P, Dupre D, Elion R, Elliott K, El-Sadr W, Estes M, Fabre J, Farrough M, Flamm J, Follansbee S, Foster C, Frank C, Franz J, Frechette G, Freidland G, Frische J, Fuentes L, Funk C, Geisler C, Genther K, Giles M, Goetz M, Gonzalez M, Graeber C, Graziano F, Grice D, Hahn B, Hamilton C, Hassler S, Henson A, Hopper S, John M, Johnson L, Johnson M, Johnson R, Jones R, Kahn J, Kelly M, Klimas N, Kolber M, Koletar S, Labriola A, Larsen R, Lasseter F, Lederman M, Ling T, Lusch T, MacArthur R, Machado C, Makohon L, Mandelke J, Mannheimer S, Markowitz N, Martínez M, Martinez N, Mass M, Masur H, McGregor D, McIntyre D, McKee J, McMullen D, Mettinger M, Middleton S, Mieras J, Mildvan D, Miller P, Miller T, Mitchell V, Mitsuyasu R, Moanna A, Mogridge C, Moran F, Murphy R, Mushatt D, Nahass R, Nixon D, O'Brien S, Ojeda J, Okhuysen P, Olson M, Osterberger J, Owen W Sr, Pablovich S, Patel S, Perez G, Pierone G Jr, Poblete R, Potter A, Preston E, Rappoport C, Regevik N, Reyelt M, Rhame F, Riney L, Rodriguez-Barradas M, Rodriguez M, Rodriguez M, Rodriguez J, Roland R, Rosmarin-DeStefano C, Rossen W, Rouff J, Saag M, Sampson J, Santiago S, Sarria J, Wirtz S, Schmidt U, Scott C, Sheridan A, Shin A, Shrader S, Simon G, Slowinski D, Smith K, Spotkov J, Sprague C, States D, Suh C, Sullivan J, Summers K, Sweeton B, Tan V, Tanner T, Tedaldi E, Temesgen Z, Thomas D, Thompson M, Tobin C, Toro N, Towner W, Upton K, Uy J, Valenti S, van der Horst C, Vita J, Voell J, Walker J, Walton T, Wason K, Watson V, Wellons A, Weise J, White M, Whitman T, Williams B, Williams N, Windham J, Witt M, Workowski K, Wortmann G, Wright T, Zelasky C, Zwickl B.

Abstract

BACKGROUND:

Used in combination with antiretroviral therapy, subcutaneous recombinant interleukin-2 raises CD4+ cell counts more than does antiretroviral therapy alone. The clinical implication of these increases is not known.

METHODS:

We conducted two trials: the Subcutaneous Recombinant, Human Interleukin-2 in HIV-Infected Patients with Low CD4+ Counts under Active Antiretroviral Therapy (SILCAAT) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). In each, patients infected with the human immunodeficiency virus (HIV) who had CD4+ cell counts of either 50 to 299 per cubic millimeter (SILCAAT) or 300 or more per cubic millimeter (ESPRIT) were randomly assigned to receive interleukin-2 plus antiretroviral therapy or antiretroviral therapy alone. The interleukin-2 regimen consisted of cycles of 5 consecutive days each, administered at 8-week intervals. The SILCAAT study involved six cycles and a dose of 4.5 million IU of interleukin-2 twice daily; ESPRIT involved three cycles and a dose of 7.5 million IU twice daily. Additional cycles were recommended to maintain the CD4+ cell count above predefined target levels. The primary end point of both studies was opportunistic disease or death from any cause.

RESULTS:

In the SILCAAT study, 1695 patients (849 receiving interleukin-2 plus antiretroviral therapy and 846 receiving antiretroviral therapy alone) who had a median CD4+ cell count of 202 cells per cubic millimeter were enrolled; in ESPRIT, 4111 patients (2071 receiving interleukin-2 plus antiretroviral therapy and 2040 receiving antiretroviral therapy alone) who had a median CD4+ cell count of 457 cells per cubic millimeter were enrolled. Over a median follow-up period of 7 to 8 years, the CD4+ cell count was higher in the interleukin-2 group than in the group receiving antiretroviral therapy alone--by 53 and 159 cells per cubic millimeter, on average, in the SILCAAT study and ESPRIT, respectively. Hazard ratios for opportunistic disease or death from any cause with interleukin-2 plus antiretroviral therapy (vs. antiretroviral therapy alone) were 0.91 (95% confidence interval [CI], 0.70 to 1.18; P=0.47) in the SILCAAT study and 0.94 (95% CI, 0.75 to 1.16; P=0.55) in ESPRIT. The hazard ratios for death from any cause and for grade 4 clinical events were 1.06 (P=0.73) and 1.10 (P=0.35), respectively, in the SILCAAT study and 0.90 (P=0.42) and 1.23 (P=0.003), respectively, in ESPRIT.

CONCLUSIONS:

Despite a substantial and sustained increase in the CD4+ cell count, as compared with antiretroviral therapy alone, interleukin-2 plus antiretroviral therapy yielded no clinical benefit in either study. (ClinicalTrials.gov numbers, NCT00004978 [ESPRIT] and NCT00013611 [SILCAAT study].)

2009 Massachusetts Medical Society

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PMID:
19828532
[PubMed - indexed for MEDLINE]
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