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Haroun E, Lim SH, Dutta D. Endari treatment ameliorates sickle cell-related disruption in intestinal barrier functions and is associated with prolonged survival in sickle cell mice. Hematology 2024; 29:2331940. [PMID: 38526293 DOI: 10.1080/16078454.2024.2331940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Endari (L-glutamine) is a conditional amino acid that reduces the frequency of vaso-occlusive crisis (VOC) in sickle cell disease (SCD). AIM To investigate whether Endari could ameliorate intestinal barrier function and improve survival outcomes in SCD. METHODS We treated female Townes SCD mice with Endari and evaluated their intestinal barrier functions by measuring the recovery of orally administered fluorescein isothiocyanate (FITC)-conjugated dextran 4 kDa in serum, and serum intestinal fatty acid binding proteins (iFABP) and lipopolysaccharide (LPS) concentrations by ELISA. We also explored the impact the Endari has on the survival of the SCD mice that underwent repeated experimentally-induced VOC. RESULTS Compared to SCD mice treated with water only, Endari-treated mice showed improved intestinal barrier functions, with decrease in the barrier permeability and reduction in the translocation of lipopolysaccharides from the intestinal lumen into the circulation. These changes occurred after only 4 weeks of Endari treatment. Improved intestinal barrier function was also associated with prolonged survival in Endari-treated SCD mice after repeated experimentally-induced VOC. CONCLUSION Our findings provide the evidence supporting the beneficial effects of Enadri in improving intestinal barrier function and associated survival outcomes in SCD.
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Affiliation(s)
- Elio Haroun
- Division of Hematology and Oncology, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Seah H Lim
- Division of Hematology and Oncology, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Oladipupo F, Stanek J, Walden J, Young J, Rose MJ, Nicol K, Villella A, Creary S. Prevalence of Duffy null and its impact on hydroxyurea in young children with sickle cell disease in the United States. Pediatr Blood Cancer 2024; 71:e30945. [PMID: 38462769 DOI: 10.1002/pbc.30945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
Consistent with studies showing a high prevalence of the Duffy null phenotype among healthy Black Americans, this retrospective study found that Duffy null was present in >75% of a young and contemporary cohort of children with sickle cell disease (SCD) in the United States. Despite the potential for this phenotype to impact absolute neutrophil counts, hydroxyurea (HU) dosing, and outcomes, it was not associated with being prescribed a lower HU dose or having increased acute SCD visits early in the HU treatment course. Future studies are needed to confirm these findings in older children with SCD.
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Affiliation(s)
- Fathia Oladipupo
- Department of Pediatrics, Center for Child Health Equity Outcomes and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph Stanek
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Joseph Walden
- Department of Pediatrics, Center for Child Health Equity Outcomes and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer Young
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Melissa J Rose
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Kathleen Nicol
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anthony Villella
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
| | - Susan Creary
- Department of Pediatrics, Center for Child Health Equity Outcomes and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Nationwide Children's Hospital, Division of Hematology/Oncology/BMT, Columbus, Ohio, USA
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Telfer P, Anie KA, Kotsiopoulou S, Aiken L, Hibbs S, Burt C, Stuart-Smith S, Lugthart S. The acute pain crisis in sickle cell disease: What can be done to improve outcomes? Blood Rev 2024; 65:101194. [PMID: 38553339 DOI: 10.1016/j.blre.2024.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/21/2024]
Abstract
The acute pain crisis (APC) is the commonest complication of sickle cell disease (SCD). Severe episodes may require treatment in hospital with strong opioid analgesic drugs, combined with additional supportive care measures. Guidelines for APC management have been produced over the past two decades gathering evidence from published studies, expert opinion, and patient perspective. Unfortunately, reports from multiple sources indicate that guidelines are often not followed, and that acute care in emergency departments and on acute medical wards is suboptimal. It is important to understand what leads to this breakdown in health care, and to identify evidence-based interventions which could be implemented to improve care. This review focuses on recently published articles as well as information about on-going clinical trials. Aspects of care which could potentially make a difference to patient experience include availability and accessibility of individual care plans agreed between patient and treating specialist, innovative means of delivering initial opioids to reduce time to first analgesia, and availability of a specialist unit away from the ED, where expert care can be delivered in a more compassionate environment. The current evidence of improved outcomes and health economic advantage with these interventions is inadequate, and this is hampering their implementation into health care systems.
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Affiliation(s)
- Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, UK; Department of Haematology, Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Kofi A Anie
- Brent Sickle Cell & Thalassaemia Centre, London North West University Healthcare NHS Trust, London, UK
| | | | - Laura Aiken
- Department of Haematology, Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Stephen Hibbs
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | - Sanne Lugthart
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, UK; Department of Haematology, University Hospitals of Bristol, Bristol, UK
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Moody AT, Narula J, Maurer TS. Quantitative Model-Based Assessment of Multiple Sickle Cell Disease Therapeutic Approaches Alone and in Combination. Clin Pharmacol Ther 2024; 115:1114-1121. [PMID: 38229405 DOI: 10.1002/cpt.3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
Three sickle cell disease (SCD) treatment strategies, stabilizing oxygenated hemoglobin (oxyHb), lowering 2,3-BPG, and inducing fetal hemoglobin (HbF) expression aim to prevent red blood cell (RBC) sickling by reducing tense-state sickle hemoglobin that contributes to polymer formation. Induction of 30% HbF is seen as the gold standard because 30% endogenous expression is associated with a lack of symptoms. However, the level of intervention required to achieve equivalent polymerization protection by the other strategies is uncertain, and there is little understanding of how these approaches could work in combination. We sought to develop an oxygen saturation model that could assess polymerization protection of all three approaches alone or in combination by extending the Monod-Wymann-Changeux model to include additional mechanisms. Applying the model to monotherapies suggests 51% sickle hemoglobin (HbS) occupancy with an oxyHb stabilizer or lowering RBC 2,3 BPG concentrations to 1.8 mM would produce comparable polymerization protection as 30% HbF. The model predictions are consistent with observed clinical response to the oxyHb stabilizer voxelotor and the 2,3-BPG reducer etavopivat. The model also suggests combination therapy will have added benefit in the case of dose limitations, as is the case for voxelotor, which the model predicts could be combined with 20% HbF or 2,3-BPG reduction to 3.75 mM to reach equivalent protection as 30% HbF. The proposed model represents a unified framework that is useful in supporting decisions in preclinical and early clinical development and capable of evolving with clinical experience to gain new and increasingly confident insights into treatment strategies for SCD.
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Affiliation(s)
- Amy T Moody
- Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Inc., Cambridge, Massachusetts, USA
| | - Jatin Narula
- Department of Biomedicine Design, Pfizer Inc., Cambridge, Massachusetts, USA
| | - Tristan S Maurer
- Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Inc., Cambridge, Massachusetts, USA
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Crego N, Douglas C, Bonnabeau E, Eason K, Earls M, Tanabe P, Shah N. Opioid Use Among Children and Adults With Sickle Cell Disease in North Carolina Medicaid Enrollees in the Era of Opioid Harm Reduction. J Pediatr Hematol Oncol 2024; 46:181-187. [PMID: 38551912 DOI: 10.1097/mph.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/12/2024] [Indexed: 04/24/2024]
Abstract
Adults and children with sickle cell disease (SCD) are predominantly African American, with pain-related health disparities. We examined opioid prescription fill patterns in adults and children with SCD and compared factors associated with fills in North Carolina Medicaid enrollees. Our retrospective cohort study included 955 enrollees diagnosed with SCD having at least one opioid fill. Associations were measured between two cohorts (12 and 24 mo of continuous enrollment) for the following characteristics: sex, age, enrollee residence, hydroxyurea adherence, comanagement, enrollment in Community Care North Carolina, prescription for short versus short and long-acting opioids, and emergency department reliance. The majority of individuals did not have an opioid claim over a 12 or 24-month period. Claims increased at ages 10 to 17, peaking at ages 18 to 30. The increased number of claims was associated with the following factors: increasing age, male, short versus long-acting opioids, and Medicaid enrollment for 24 versus 12 months. Community Care North Carolina enrollees in the 12-month cohort had higher opioid days of supply per month; the inverse was true of the 24-month cohort.
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Affiliation(s)
| | | | | | - Kern Eason
- School of Medicine, Duke University, Durham
| | | | - Paula Tanabe
- School of Nursing
- School of Medicine, Duke University, Durham
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Njoku F, Pugh N, Brambilla D, Kroner B, Shah N, Treadwell M, Gibson R, Hsu LL, Gordeuk VR, Glassberg J, Hankins JS, Kutlar A, King AA, Kanter J. Mortality in adults with sickle cell disease: Results from the sickle cell disease implementation consortium (SCDIC) registry. Am J Hematol 2024; 99:900-909. [PMID: 38450756 PMCID: PMC11001513 DOI: 10.1002/ajh.27279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
The cause of death in people affected by sickle cell disease (SCD) is often challenging to define as prior studies have used retrospective or administrative data for analysis. We used a prospective longitudinal registry to assess mortality and clinical co-morbidities among subjects enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. At enrollment, we collected the following data: patient-reported demographics, SCD phenotype, baseline laboratory values, comorbidities, and current medications. Subjects were followed for a median of 4.7 years before the present analysis. The relationship of clinical co-morbidities (at time of enrollment) to mortality was determined using survival analysis, adjusting for SCD phenotype and gender. There was a total of 2439 people with SCD enrolled in the SCDIC registry. One hundred and twenty-eight participants (5%) died during the observation period (2017-2022). Six people died from trauma and were excluded from further analysis. Proximate cause of death was unwitnessed in 17% of the deaths, but commonest causes of death include cardiac (18%), acute chest or respiratory failure (11%), sudden unexplained death (8%). Enrollment characteristics of the individuals who died (n = 122) were compared to those of survivors (n = 2317). Several co-morbidities at enrollment increased the odds of death on univariate analysis. All co-morbidities were included in a multivariable model. After backward elimination, iron overload, pulmonary hypertension, and depression, remained statistically significant predictors of the risk of death. SCD reduces life expectancy. Improved comprehensive and supportive care to prevent end-organ damage and address comorbidities is needed for this population.
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Affiliation(s)
- Franklin Njoku
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Norma Pugh
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Donald Brambilla
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Kroner
- Department of Clinical Research, SSES, RTI International, Research Triangle Park, North Carolina, USA
| | - Nirmish Shah
- Pediatric Hematology/Oncology, Duke University, Durham, North Carolina, USA
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, University of California San Francisco, Oakland, California, USA
| | - Robert Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia
| | - Lewis L. Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jane S. Hankins
- Departments of Hematology and Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Abdullah Kutlar
- Sickle Cell Center, Augusta University, Augusta, Georgia, USA
| | - Allison A. King
- Division of Pediatric Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
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Garg AK, Scott AW. Systemic medications for sickle cell disease and potential applications for sickle cell retinopathy. Curr Opin Ophthalmol 2024; 35:185-191. [PMID: 38465910 DOI: 10.1097/icu.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW To review the literature evaluating systemic medications for treatment of sickle cell disease (SCD) and their applications for sickle cell retinopathy. RECENT FINDINGS Prior studies have demonstrated the efficacy of traditional systemic therapies in reducing the risk of development of sickle cell retinopathy. Since 2017, several new and promising disease-modifying therapies for sickle cell disease have been approved for clinical use, including the first genetic therapies such as exagamglogene autotemcel (exa-cel) and lovotibeglogene autotemcel (lovo-cel). These treatments have shown promising results for systemic management but are not widely utilized due to limited access and high cost. The efficacy of these therapies for the prevention of sickle cell retinopathy remains unknown and opens the door to new avenues for research. Furthermore, the role of systemic therapy for the management of hemoglobin SC (HbSC) disease, which has milder systemic effects but higher likelihood of causing retinopathy, remains poorly understood. SUMMARY Hydroxyurea has been a mainstay of systemic management of SCD with prior work suggesting its ability to reduce the likelihood of developing retinopathy. There are several new and potentially curative systemic therapies for SCD, though their role in retinopathy prevention and management has not been studied extensively. Future studies are necessary to understand the implications of these emerging therapies for sickle cell retinopathy.
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Affiliation(s)
- Anupam K Garg
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Razazi K, Berti E, Cecchini J, Carteaux G, Habibi A, Bartolucci P, Arrestier R, Gendreau S, de Prost N, Hulin A, Dessap AM. Decreased risk of underdosing with continuous infusion versus intermittent administration of cefotaxime in patients with sickle cell disease and acute chest syndrome. PLoS One 2024; 19:e0302298. [PMID: 38635540 PMCID: PMC11025818 DOI: 10.1371/journal.pone.0302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Underdosing of antibiotics is common in patients with sickle cell disease (SCD). We hypothesized that in critically-ill patients with SCD receiving cefotaxime during acute chest syndrome, the continuous infusion may outperform the intermittent administration in achieving pharmacokinetic/pharmacodynamic targets. DESIGN Prospective before-after study. SETTINGS Intensive-care unit of a French teaching hospital and sickle cell disease referral center. PATIENTS Sixty consecutive episodes of severe acute chest syndrome in 58 adult patients with sickle cell disease. INTERVENTIONS Patients were treated with intermittent administration during the first period (April 2016 -April 2018) and with continuous infusion during the second period (May 2018 -August 2019). MEASUREMENTS AND MAIN RESULTS We included 60 episodes of acute chest syndrome in 58 patients (29 [25-34] years, 37/58 (64%) males). Daily dose of cefotaxime was similar between groups (59 [48-88] vs. 61 [57-64] mg/kg/day, p = 0.84). Most patients (>75%) presented a glomerular hyperfiltration with no difference between groups (p = 0.25). More patients had a cefotaxime trough level ≥2 mg/L with continuous infusion than intermittent administration: 28 (93%) vs. 5 (16%), p<0.001. The median residual concentration was higher in the continuous infusion than intermittent administration group: 10.5 [7.4-13.3] vs. 0 [0-0] mg/L, p<0.001. No infection relapse was observed in the entire cohort. Hospital length of stay was similar between groups. CONCLUSION As compared to intermittent administration, continuous infusion of cefotaxime maximizes the pharmacokinetic/pharmacodynamic parameters in patients with SCD. The clinical outcome did not differ between the two administration methods; however, the study was underpowered to detect such a difference.
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Affiliation(s)
- Keyvan Razazi
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Enora Berti
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Jerome Cecchini
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Hôpital Intercommunal de Créteil, Service de Réanimation et Surveillance Continue Adulte, 94000, Créteil, France
| | - Guillaume Carteaux
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Anoosha Habibi
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Centre de Référence de la Drépanocytose, Créteil, France
| | - Pablo Bartolucci
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Centre de Référence de la Drépanocytose, Créteil, France
| | - Romain Arrestier
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Ségolène Gendreau
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Nicolas de Prost
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
| | - Anne Hulin
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Biochimie, Créteil, 94010 France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
- Université Paris Est Créteil, CARMAS, Créteil, F-94010, France
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Namazzi R, Bond C, Conroy AL, Datta D, Tagoola A, Goings MJ, Jang JH, Ware RE, Opoka R, John CC. Hydroxyurea reduces infections in children with sickle cell anemia in Uganda. Blood 2024; 143:1425-1428. [PMID: 38169476 PMCID: PMC11033589 DOI: 10.1182/blood.2023021575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT After starting hydroxyurea treatment, Ugandan children with sickle cell anemia had 60% fewer severe or invasive infections, including malaria, bacteremia, respiratory tract infections, and gastroenteritis, than before starting hydroxyurea treatment (incidence rate ratio, 0.40 [95% confidence interval, 0.29-0.54]; P < .001).
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Affiliation(s)
- Ruth Namazzi
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Caitlin Bond
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Andrea L. Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Dibyadyuti Datta
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Abner Tagoola
- Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Michael J. Goings
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Jeong Hoon Jang
- Underwood International College and Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - Russell E. Ware
- Division of Hematology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Chandy C. John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
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Green NS, Manwani D, Aygun B, Appiah-Kubi A, Smith-Whitley K, Castillo Y, Soriano L, Jia H, Smaldone AM. Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT) efficacy trial: Community health worker support may increase hydroxyurea adherence of youth with sickle cell disease. Pediatr Blood Cancer 2024; 71:e30878. [PMID: 38321562 PMCID: PMC10919354 DOI: 10.1002/pbc.30878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024]
Abstract
Despite disease-modifying effects of hydroxyurea on sickle cell disease (SCD), poor adherence among affected youth commonly impedes treatment impact. Following our prior feasibility trial, the "Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT)" multi-site randomized controlled efficacy trial aimed to increase hydroxyurea adherence for youth with SCD ages 10-18 years. Impaired adherence was identified primarily through flagging hydroxyurea-induced fetal hemoglobin (HbF) levels compared to prior highest treatment-related HbF. Eligible youth were enrolled as dyads with their primary caregivers for the 1-year trial. This novel semi-structured supportive, multidimensional dyad intervention led by community health workers (CHW), was augmented by daily tailored text message reminders, compared to standard care during a 6-month intervention phase, followed by a 6-month sustainability phase. Primary outcomes from the intervention phase were improved Month 6 HbF levels compared to enrollment and proportion of days covered (PDC) for hydroxyurea versus pre-trial year. The secondary outcome was sustainability of changes up to Month 12. The 2020-2021 peak coronavirus disease 2019 (COVID-19) pandemic disrupted enrollment and clinic-based procedures; CHW in-person visits shifted to virtual scheduled interactions. We enrolled 50 dyads, missing target enrollment. Compared to enrollment levels, both HbF level and PDC significantly - but not sustainably - improved within the intervention group (p = .03 and .01, respectively) with parallel increased mean corpuscular volume (MCV) (p = .05), but not within controls. No significant between-group differences were found at Months 6 or 12. These findings suggest that our community-based, multimodal support for youth-caregiver dyads had temporarily improved hydroxyurea usage. Durability of impact should be tested in a trial with longer duration of CHW-led and mobile health support.
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Affiliation(s)
- Nancy S. Green
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, NY
| | - Deepa Manwani
- Department of Pediatrics, Division of Hematology, Oncology and Cellular Therapy, Albert Einstein College of Medicine, NY
| | - Banu Aygun
- Department of Pediatrics, Division of Hematology, Oncology and Cellular Therapy, Cohen Children’s Medical Center, NY
| | - Abena Appiah-Kubi
- Department of Pediatrics, Division of Hematology, Oncology and Cellular Therapy, Cohen Children’s Medical Center, NY
| | - Kim Smith-Whitley
- Division of Hematology, Children’s Hospital of Philadelphia, PA
- Pfizer, Inc., NY
| | - Yina Castillo
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, NY
| | - Lucy Soriano
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, NY
| | - Haomiao Jia
- School of Nursing, Columbia University Irving Medical Center, NY
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Houwing ME, Bos J, van Wijk R, van Beers EJ, Cnossen MH, Rab MAE. Use of the oxygen gradient ektacytometry in the dose titration of hydroxyurea therapy in children with sickle cell disease. Int J Lab Hematol 2024; 46:390-394. [PMID: 38105480 DOI: 10.1111/ijlh.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Maite E Houwing
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jennifer Bos
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eduard J van Beers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Minke A E Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Dubey RK, Vats R, Brzoska T, Kaminski TW, Katoch O, Tejero J, Njikang G, Paderi J, Sundd P. Subcutaneous injection of IHP-102 prevents lung vaso-occlusion in sickle cell disease mice. Haematologica 2024; 109:1259-1263. [PMID: 37855052 PMCID: PMC10985437 DOI: 10.3324/haematol.2023.283716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
Not available.
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Affiliation(s)
- Rikesh K. Dubey
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, WI
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ravi Vats
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Tomasz Brzoska
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Tomasz W. Kaminski
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, WI
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Omika Katoch
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, WI
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jesus Tejero
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Prithu Sundd
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, WI
- Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
- Sickle Cell Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA RKD and RV contributed equally as first authors
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13
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Snyder AB, Zhou M, Attell BK, Cohen LL, Carter S, Bock F, Dampier C. Opioid Use After First Opioid Prescription in Children With Sickle Cell Disease. JAMA Pediatr 2024; 178:408-410. [PMID: 38372994 PMCID: PMC10877502 DOI: 10.1001/jamapediatrics.2023.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/01/2023] [Indexed: 02/20/2024]
Abstract
This cohort study assesses the level of opioid use, number of vaso-occlusive crises, and days’ supply of opioids among opioid-naive pediatric patients.
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Affiliation(s)
| | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, Atlanta
| | | | | | - Sierra Carter
- Psychology Department, Georgia State University, Atlanta
| | - Fiona Bock
- Georgia Health Policy Center, Georgia State University, Atlanta
| | - Carlton Dampier
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Power-Hays A, Tomlinson GA, Tshilolo L, Santos B, Williams TN, Olupot-Olupot P, Smart LR, Aygun B, Lane A, Stuber SE, Latham T, Ware RE. Reducing transfusion utilization for children with sickle cell anemia in sub-Saharan Africa with hydroxyurea: Analysis from the phase I/II REACH trial. Am J Hematol 2024; 99:625-632. [PMID: 38332651 DOI: 10.1002/ajh.27244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
Children with sickle cell anemia (SCA) in Africa frequently require transfusions for SCA complications. Despite limited blood supplies, strategies to reduce their transfusion needs have not been widely evaluated or implemented. We analyzed transfusion utilization in children with SCA before and during hydroxyurea treatment. REACH (Realizing Effectiveness Across Continents with Hydroxyurea, NCT01966731) is a longitudinal Phase I/II trial of hydroxyurea in children with SCA from Angola, Democratic Republic of Congo, Kenya, and Uganda. After enrollment, children had a two-month pre-treatment screening period followed by 6 months of fixed-dose hydroxyurea (15-20 mg/kg/day), 18 months of dose escalation, and then stable dosing at maximum tolerated dose (MTD). Characteristics associated with transfusions were analyzed with univariate and multivariable models. Transfusion incidence rate ratios (IRR) across treatment periods were calculated. Among 635 enrolled children with 4124 person-years of observation, 258 participants (40.4%) received 545 transfusions. The transfusion rate per 100 person-years was 43.2 before hydroxyurea, 21.7 on fixed-dose, 14.5 during dose escalation, and 10.8 on MTD. During MTD, transfusion incidence was reduced by 75% compared to pre-treatment (IRR 0.25, 95% confidence interval [CI] 0.18-0.35, p < .0001), and by 50% compared to fixed dose (IRR 0.50, 95% CI 0.39-0.63, p < .0001). Hydroxyurea at MTD decreases transfusion utilization in African children with SCA. If widely implemented, universal testing and hydroxyurea treatment at MTD could potentially prevent 21% of all pediatric transfusions administered in sub-Saharan Africa. Increasing hydroxyurea access for SCA should decrease the transfusion burden and increase the overall blood supply.
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Affiliation(s)
- Alexandra Power-Hays
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - George A Tomlinson
- Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Leon Tshilolo
- Department of Medicine, Centre Hospitalier Monkole, Kinshasa, Congo
| | - Brígida Santos
- Instituto Hematológico Pediátrico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | | | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale Regional Referral and Teaching Hospital-Busitema University, Mbale, Uganda
| | - Luke R Smart
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Banu Aygun
- Division of Hematology, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
| | - Adam Lane
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan E Stuber
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teresa Latham
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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15
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Allali S, Galactéros F, Oevermann L, Cannas G, Joseph L, Loko G, Elenga N, Benkerrou M, Etienne-Julan M, Castex MP, Brousse V, de Montalembert M. Hydroxyurea is associated with later onset of acute splenic sequestration crisis in sickle cell disease: Lessons from the European Sickle Cell Disease Cohort-Hydroxyurea (ESCORT-HU) study. Am J Hematol 2024; 99:555-561. [PMID: 38247384 DOI: 10.1002/ajh.27214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
Acute splenic sequestration crisis (ASSC) is a potentially life-threatening complication of sickle cell disease (SCD), typically occurring in young patients under 5 years of age, with a median age at first episode of less than 2 years. Because a beneficial effect of hydroxyurea (HU) on spleen perfusion and splenic function has been suspected, we hypothesized that HU treatment might be associated with later onset of ASSC in patients with SCD. To investigate this hypothesis, we analyzed data from the ESCORT-HU study on a large cohort of patients with SCD receiving HU, enrolled between January 2009 and June 2017 with a follow-up of 7309 patient-years of observation. The median age at ASSC of the 14 patients who experienced a first episode of ASSC during the study period was 8.0 [IQR: 5.0-24.1] years. The median age at HU initiation was significantly lower in these 14 patients (4.8 [IQR: 3.3-18.7] years) compared to the 1664 patients without ASSC (19.9 [8.8-33.4] years, p = .0008). These findings suggest that ASSC may occur at an unusually late age in patients receiving HU, possibly reflecting longer preservation of spleen perfusion and function secondary to early initiation of HU. Further studies are needed to better characterize the effects of HU on spleen perfusion/function and on the occurrence of ASSC in patients with SCD (ClinicalTrials.gov identifier: NCT02516579; European registry ENCEPP/SDPP/10565).
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Affiliation(s)
- Slimane Allali
- Department of General Pediatrics and Pediatric Infectious Diseases, Reference Center for Sickle Cell Disease, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Frédéric Galactéros
- Department of Internal Medicine, Sickle Cell Referral Center, Henri-Mondor University Hospital-UPEC, AP-HP, Créteil, France
| | - Lena Oevermann
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin and Berlin Institute of Health, Berlin, Germany
| | - Giovanna Cannas
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Médecine Interne, Centre de Référence Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse, Lyon, France
| | - Laure Joseph
- Biotherapy Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Gylna Loko
- Centre Hospitalier Universitaire de Martinique, Centre de Référence Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Érythropoïèse des Antilles et de la Guyane, Le Lamentin, Martinique, France
| | - Narcisse Elenga
- Centre Hospitalier de Cayenne, Centre de Référence Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse, Cayenne, French Guiana
| | - Malika Benkerrou
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Inserm, UMR-1123 ECEVE, Université Paris Cité, Paris, France
| | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose, Centre de Référence Maladies Rares pour la Drépanocytose aux Antilles-Guyane, CHU de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Marie-Pierre Castex
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital - Toulouse University Hospital, Toulouse, France
| | - Valentine Brousse
- Department of General Pediatrics and Pediatric Infectious Diseases, Reference Center for Sickle Cell Disease, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Inserm, UMR-1123 ECEVE, Université Paris Cité, Paris, France
| | - Mariane de Montalembert
- Department of General Pediatrics and Pediatric Infectious Diseases, Reference Center for Sickle Cell Disease, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
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16
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Gérardin M, Rousselet M, Couec ML, Masseau A, Aquizerate A, Authier N, Deheul S, Roussin A, Micallef J, Djezzar S, Feuillet F, Jolliet P, Grall-Bronnec M, Victorri-Vigneau C. Substance use disorder of equimolar oxygen-nitrous oxide mixture in French sickle-cell patients: results of the PHEDRE study. Orphanet J Rare Dis 2024; 19:124. [PMID: 38500184 PMCID: PMC10949610 DOI: 10.1186/s13023-024-03133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In many countries, nitrous oxide is used in a gas mixture (EMONO) for short-term analgesia. Cases of addiction, with significant misuse, have been reported in hospitalized patients. Patients suffering from sickle cell disease (SCD) could represent a high-risk population for substance use disorder (SUD) due to their significant pain crisis and repeated use of EMONO. The objective of the PHEDRE study was to assess the prevalence of SUD for EMONO in French SCD patients. RESULTS A total of 993 patients were included. Among 339 EMONO consumers, only 38 (11%) had a SUD, with very few criteria, corresponding mainly to a mild SUD due to a use higher than expected (in quantity or duration) and relational tensions with the care teams. Almost all patients (99.7%) were looking for an analgesic effect, but 68% of patients were also looking for other effects. The independent risks factors associated with at least one SUD criterion were: the feeling of effects different from the expected therapeutic effects of EMONO, at least one hospitalization for vaso occlusive crisis in the past 12 months and the presence of a SUD for at least one other analgesic drug. CONCLUSIONS The use of EMONO was not problematic for the majority of patients. Manifestations of SUD that led to tensions with healthcare teams should alert and lead to an evaluation, to distinguish a true addiction from a pseudoaddiction which may be linked to an insufficient analgesic treatment related to an underestimation of pain in SCD patients. TRIAL REGISTRATION Clinical Trials, NCT02580565. Registered 16 October 2015, https://clinicaltrials.gov/.
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Affiliation(s)
- Marie Gérardin
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
| | - Morgane Rousselet
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Marie-Laure Couec
- CHU Nantes, Service de Pédiatrie et d'Oncologie Pédiatrique, Nantes Université, Nantes, France
| | - Agathe Masseau
- CHU Nantes, Service de Médecine Interne, Nantes Université, Nantes, France
| | - Aurélie Aquizerate
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Clermont Auvergne Université, Clermont-Ferrand, France
| | - Sylvie Deheul
- CHU Lille, Service de Pharmacologie, Lille Université, Lille, France
| | - Anne Roussin
- CHU Toulouse, Service de Pharmacologie Médicale et Clinique, Toulouse Université, Toulouse, France
| | - Joelle Micallef
- APHM, Service de Pharmacologie Clinique, Hôpital de La Timone, Institut de Neurosciences Des Systèmes, Aix-Marseille Université, Marseille, France
| | - Samira Djezzar
- APHP Paris, Centre d'Evaluation et d'Information sur la Pharmacodependence-Addictovigilance de Paris, Hôpital Fernand Widal, APHP Paris, Paris, France
| | - Fanny Feuillet
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
- CHU Nantes, DRI, Plateforme de Méthodologie et Biostatistique, Nantes Université, Nantes, France
| | - Pascale Jolliet
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France.
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France.
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17
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Pires CV, Cassandra D, Xu S, Laleu B, Burrows JN, Adams JH. Oxidative stress changes the effectiveness of artemisinin in Plasmodium falciparum. mBio 2024; 15:e0316923. [PMID: 38323831 PMCID: PMC10936410 DOI: 10.1128/mbio.03169-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Malaria parasites have adaptive mechanisms to modulate their intracellular redox status to tolerate the enhanced oxidizing effects created by malaria fever, hemoglobinopathies and other stress conditions, including antimalaria drugs. Emerging artemisinin (ART) resistance in Plasmodium falciparum is a complex phenotype linked to the parasite's tolerance of the activated drug's oxidative damage along with changes in vesicular transport, lipid metabolism, DNA repair, and exported proteins. In an earlier study, we discovered that many of these metabolic processes are induced in P. falciparum to respond to the oxidative damage caused by artemisinin, which exhibited a highly significant overlap with the parasite's adaptive response mechanisms to survive febrile temperatures. In addition, there was a significant overlap with the parasite's survival responses to oxidative stress. In this study, we investigated these relationships further using an in vitro model to evaluate if oxidative stress and heat-shock conditions could alter the parasite's response to artemisinin. The results revealed that compared to ideal culture conditions, the antimalarial efficacy of artemisinin was significantly reduced in parasites growing in intraerythrocytic oxidative stress but not in heat-shock condition. In contrast, heat shock significantly reduced the efficacy of lumefantrine that is an important ART combination therapy partner drug. We propose that prolonged exposure to intraerythrocytic microenvironmental oxidative stress, as would occur in endemic regions with high prevalence for sickle trait and other hemoglobinopathies, can predispose malaria parasites to develop tolerance to the oxidative damage caused by antimalarial drugs like artemisinin. IMPORTANCE Emerging resistance to the frontline antimalarial drug artemisinin represents a significant threat to worldwide malaria control and elimination. The patterns of parasite changes associated with emerging resistance represent a complex array of metabolic processes evident in various genetic mutations and altered transcription profiles. Genetic factors identified in regulating P. falciparum sensitivity to artemisinin overlap with the parasite's responses to malarial fever, sickle trait, and other types of oxidative stresses, suggesting conserved inducible survival responses. In this study we show that intraerythrocytic stress conditions, oxidative stress and heat shock, can significantly decrease the sensitivity of the parasite to artemisinin and lumefantrine, respectively. These results indicate that an intraerythrocytic oxidative stress microenvironment and heat-shock condition can alter antimalarial drug efficacy. Evaluating efficacy of antimalarial drugs under ideal in vitro culture conditions may not accurately predict drug efficacy in all malaria patients.
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Affiliation(s)
- Camilla Valente Pires
- Center for Global Health and Interdisciplinary Diseases Research and USF Genomics Program, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Debora Cassandra
- Center for Global Health and Interdisciplinary Diseases Research and USF Genomics Program, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Shulin Xu
- Center for Global Health and Interdisciplinary Diseases Research and USF Genomics Program, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Benoit Laleu
- Medicines for Malaria Venture, ICC, Geneva, Switzerland
| | | | - John H. Adams
- Center for Global Health and Interdisciplinary Diseases Research and USF Genomics Program, College of Public Health, University of South Florida, Tampa, Florida, USA
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18
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Parekh DS, Eaton WA, Thein SL. Recent developments in the use of pyruvate kinase activators as a new approach for treating sickle cell disease. Blood 2024; 143:866-871. [PMID: 38118071 PMCID: PMC10940061 DOI: 10.1182/blood.2023021167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 12/22/2023] Open
Abstract
ABSTRACT Pyruvate kinase (PK) is a key enzyme in glycolysis, the sole source of adenosine triphosphate, which is essential for all energy-dependent activities of red blood cells. Activating PK shows great potential for treating a broad range of hemolytic anemias beyond PK deficiency, because they also enhance activity of wild-type PK. Motivated by observations of sickle-cell complications in sickle-trait individuals with concomitant PK deficiency, activating endogenous PK offers a novel and promising approach for treating patients with sickle-cell disease.
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Affiliation(s)
- Dina S. Parekh
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - William A. Eaton
- Laboratory of Chemical Physics, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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19
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Sheridan C. Innovators want pills to treat sickle cell disease. Can they match gene therapy? Nat Biotechnol 2024; 42:347-350. [PMID: 38491281 DOI: 10.1038/s41587-024-02179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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20
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Hoy SM. Exagamglogene Autotemcel: First Approval. Mol Diagn Ther 2024; 28:133-139. [PMID: 38228954 DOI: 10.1007/s40291-024-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/18/2024]
Abstract
Exagamglogene autotemcel (Casgevy™) is a genetically modified autologous CD34+ cell enriched population. It contains human haematopoietic stem and progenitor cells edited ex vivo by CRISPR/Cas9 (a DNA double strand break-inducing nuclease system) to differentiate into erythroid cells that produce high levels of foetal hemoglobin. Developed by Vertex Pharmaceuticals and CRISPR Therapeutics, exagamglogene autotemcel received its first approval on 16 November 2023 in the UK for the treatment of transfusion-dependent β-thalassemia (TDT) in patients aged ≥ 12 years for whom haematopoietic stem cell (HSC) transplantation is appropriate and a human leukocyte antigen matched related HSC donor is not available. On the same day, it was also approved in the UK for the treatment of sickle cell disease (SCD) in patients aged ≥ 12 years with recurrent vasoocclusive crises (VOCs) who have the βS/βS, βS/β+ or βS/β0 genotype for whom HSC transplantation is appropriate and a human leukocyte antigen matched related HSC donor is not available. Subsequently, exagamglogene autotemcel was approved in the USA on 8 December 2023 for the treatment of SCD in patients aged ≥ 12 years with recurrent VOCs and received a positive opinion in the EU on 14 December 2023 for the treatment of TDT and SCD. A regulatory assessment of exagamglogene autotemcel is currently underway for the treatment of TDT in the USA. This article summarizes the milestones in the development of exagamglogene autotemcel leading to these first approvals.
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Affiliation(s)
- Sheridan M Hoy
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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21
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Kaçmaz M, İlhan G. A comparison of the mixed and sequential use of acetaminophen and dexketoprofen in painful vaso-occlusive crises. Eur J Clin Pharmacol 2024; 80:475-480. [PMID: 38245872 DOI: 10.1007/s00228-024-03630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Opioids are widely used to treat painful vaso-occlusive crises (VOC) in sickle cell disease (SCD). However, due to opioids' significant adverse effect profiles, the search for alternative therapies continues from the past to the present. The study aimed to investigate the efficacy of acetaminophen and dexketoprofen in the treatment of painful VOC. METHODS This study is a single-center, prospective, non-randomized, single-blinded, controlled study. The study comprised two groups: the first administered acetaminophen and dexketoprofen mixed group, while the second received them sequential group. Opioids were used in patients with persistent pain despite these analgesics. Demographic and laboratory information, pain scores, opioid requirement, dose amount, side effects, and length of hospital stay of the patients were recorded. RESULTS The study comprised 56 (100%) patients with painful VOC, 29 (51.8%) from the mixed group, and 27 (48.2%) from the sequential group. Opioid use was seen in 16 (55.2%) patients in the mixed group and 21 (77.8%) patients in the sequential group (p = 0.074). The median amount of opioid used was significantly lower in the mixed group than in the sequential group (p < 0.001). Also, the median length of hospital stay was significantly lower in the mixed group than in the sequential group (p < 0.001). CONCLUSION Our study suggests that administering acetaminophen and dexketoprofen in the mix for the treatment of painful VOC in patients with SCD may be a more efficient approach compared to sequential administration. This approach appears to reduce opioid usage and shorten hospital stays.
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Affiliation(s)
- Murat Kaçmaz
- Department of Hematology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Gül İlhan
- Department of Hematology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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22
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Ogu UO, Mukhopadhyay A, Patel K, Nelson MN, Strahan KS, Wu L, Smeltzer MP, Ataga KI. Hydroxyurea at escalated dose versus fixed low-dose hydroxyurea in adults with sickle cell disease. Eur J Haematol 2024; 112:466-474. [PMID: 38019026 PMCID: PMC10922392 DOI: 10.1111/ejh.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023]
Abstract
Hydroxyurea reduces the frequency of vaso-occlusive complications, increases hemoglobin, and decreases mortality in sickle cell disease (SCD). Although current guidelines recommend escalation to maximum tolerated dose (MTD), the use of fixed low-dose hydroxyurea is common in low-resource countries. We conducted a systematic review and meta-analysis to evaluate the efficacy of escalated doses versus fixed low-dose of hydroxyurea in adults with SCD. Nine studies were included in the quantitative synthesis, four evaluating fixed low-dose and five evaluating escalated doses of hydroxyurea. Average daily doses of hydroxyurea in the fixed low-dose and escalated dose studies were ~10 and 22 mg/kg, respectively. There was no difference in the estimate of vaso-occlusive crisis rate between escalated and fixed low-dose studies (p = .73). The mean difference in hemoglobin from baseline to follow-up was greater for fixed low-dose than escalated dose studies (1.07 g/dL vs. 0.54 g/dL, p = .01). No difference was seen in the mean estimate of fetal hemoglobin. Despite limited eligible studies and substantial heterogeneity of effect between the studies for several outcomes, there appears to be clinical equipoise regarding the most appropriate hydroxyurea dosing regimen in adults with SCD. Controlled studies of hydroxyurea at MTD versus fixed low-dose in adults with SCD are required.
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Affiliation(s)
- Ugochi O. Ogu
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Kruti Patel
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Marquita N. Nelson
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - KayLee S. Strahan
- Northwest Campus Library, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Lin Wu
- Research and Learning Services, Health Science Library, University of Tennessee Health Science Center, Memphis, TN
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
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23
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Sadaf A, Dong M, Pfeiffer A, Latham T, Kalfa T, Vinks AA, Ware RE, Quinn CT. A Population Pharmacokinetic Analysis of L-Glutamine Exposure in Patients with Sickle Cell Disease: Evaluation of Dose and Food Effects. Clin Pharmacokinet 2024; 63:357-365. [PMID: 38401036 PMCID: PMC10954986 DOI: 10.1007/s40262-024-01349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND OBJECTIVE L-Glutamine is a treatment for children and adults with sickle cell disease. A comprehensive evaluation of the pharmacokinetics of L-glutamine in sickle cell disease has not been conducted. We aimed to assess the effects of long-term dosing, multiple dose levels, and food intake on L-glutamine exposure in patients with sickle cell disease compared to normal participants. METHODS We conducted an open-label dose-ascending trial of L-glutamine in pediatric and adult participants with sickle cell disease (N = 8) and adult healthy volunteers (N = 4), providing a total of 400 plasma L-glutamine concentrations. Each participant received three ascending oral doses (0.1 and 0.3 g/kg twice daily and 0.6 g/kg once daily) over 3 weeks. Plasma L-glutamine concentrations were quantified using ion exchange chromatography. Both a non-compartmental pharmacokinetic analysis and a population pharmacokinetic analysis were performed. RESULTS L-glutamine had rapid absorption and elimination, and there was no significant change in the baseline (pre-dose) L-glutamine concentration throughout the study, indicating no drug accumulation. Pharmacokinetics was best described by a one-compartment model with first-order kinetics. The dose-normalized peak concentration decreased with dose escalation, indicating the capacity-limited non-linear pharmacokinetics of oral L-glutamine. A covariate analysis showed that baseline L-glutamine concentrations correlated negatively with glutamine clearance, whereas dose positively correlated with volume of distribution. Food intake did not significantly affect glutamine clearance, indicating that L-glutamine can be taken with or without food. CONCLUSIONS We report the first pharmacokinetic study of multiple-dose, long-term oral L-glutamine therapy and the first population pharmacokinetic analysis of L-glutamine for sickle cell disease. These findings may permit optimized dosing of L-glutamine for patients with sickle cell disease to maximize treatment benefits. CLINICAL TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT04684381).
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Affiliation(s)
- Alina Sadaf
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
| | - Min Dong
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amanda Pfeiffer
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
| | - Teresa Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
| | - Theodosia Kalfa
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles T Quinn
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Hematology ML, 3333 Burnet Ave., Cincinnati, OH, 701545229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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24
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Prince E, Loeser P, Early M, Carroll CP, Lanzkron S, Pecker LH. "Buprenorphine, It Works so Differently": Adults with Sickle Cell Disease Describe Transitioning to Buprenorphine for Treatment of Chronic Pain. J Pain 2024; 25:632-641. [PMID: 37742907 PMCID: PMC11002816 DOI: 10.1016/j.jpain.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
A growing body of literature describes the use of buprenorphine for the treatment of chronic pain in people with sickle cell disease. The experiences of people with sickle cell disease who have tried buprenorphine have not yet reported. This qualitative descriptive study was conducted to explore perspectives on buprenorphine for chronic pain in sickle cell disease. We interviewed 13 participants with sickle cell disease who had been prescribed buprenorphine and had a clinic visit between December 1, 2020, and April 2022 in our Sickle Cell Center for Adults. Interviews were recorded, transcribed, and analyzed using thematic analysis. Eleven out of 13 participants were taking buprenorphine at the time of the interview, with a mean treatment duration of 33 months (SD 18, range 7-78 months). Five major themes were identified: 1) dissatisfaction with full agonist opioids; 2) navigating uncertainty with autonomy in deciding to try buprenorphine; 3) functional and relational changes after starting buprenorphine, 4) enduring systemic barriers to pain treatment, and 5) trusting treatment relationships are necessary when approaching patients about buprenorphine. The experience of adulthood living with sickle cell disease before and after starting buprenorphine is qualitatively different with significant improvements in social functioning. PERSPECTIVE: This study examined the experience of adults with sickle cell disease and chronic pain transitioning from full agonist opioids to buprenorphine. It is the first qualitative study of buprenorphine in people with sickle cell disease, contributing to a small but growing literature about buprenorphine and sickle cell disease.
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Affiliation(s)
- Elizabeth Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | | | - Macy Early
- Johns Hopkins University School of Medicine, Baltimore MD
| | - C. Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore MD
| | - Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore MD
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore MD
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25
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Onyebuchi CO, Chumpitazi CE, Placencia JL, Jackson AN, Jones JL, Torres L, Tubman VN. Ketamine for Pain in Sickle Cell Disease Reduces Opioid Usage. J Pain Symptom Manage 2024; 67:e169-e175. [PMID: 38000561 DOI: 10.1016/j.jpainsymman.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
CONTEXT Pain attributable to sickle cell disease (SCD) is often unpredictable, recurrent, and requires complex treatments. Subanesthetic ketamine infusion has been studied in other diseases and disorders, but there is still limited data on its efficacy in pain management for SCD. OBJECTIVES The primary objective is to determine if subanesthetic ketamine infusion reduces pain scores and opioid requirements in hospitalized pediatric patients with SCD. RESULTS Forty-six admissions among 22 patients between February 2018 and December 2019 were analyzed. We observed decrease in pain scores within 24 hours of ketamine initiation in 34 of 46 admissions (mean pain score per patient before ketamine initiation: 2.2-9.7, mean pain score per patient after ketamine initiation: 0-9.7; P < .05). We observed a decrease in pain scores in the remaining 12 admissions after greater than 24 hours of ketamine initiation. Opioid usage declined after ketamine infusion, with a difference of means in oral morphine equivalents before and after ketamine of 122.8 mg/day. The side effects observed with ketamine infusion included hallucinations in 11 (23.9%) admissions. Only four (8.7%) admissions required cessation of the infusion due to side effects. The readmission rate at two weeks and four weeks after first ketamine infusion was the same (12.5%) at both time points. For all patients in the cohort, the introduction of ketamine into pain regimens did not reduce the number of admissions in the year following ketamine initiation relative to the year prior. CONCLUSION In pediatric patients with SCD, subanesthetic ketamine was safe as a continuous infusion and effectively reduced both pain scores and opioid requirements.
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Affiliation(s)
| | - Corrie E Chumpitazi
- Department of Pediatrics, Division of Emergency Medicine (C.C., J.L.), Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital (C.C., J.P., A.J.), Houston, Texas, USA
| | | | - Andrea N Jackson
- Texas Children's Hospital (C.C., J.P., A.J.), Houston, Texas, USA
| | - Jennifer L Jones
- Department of Pediatrics, Division of Emergency Medicine (C.C., J.L.), Baylor College of Medicine, Houston, Texas, USA
| | - Laura Torres
- Deparment of Anesthesiology (L.T.), Baylor College of Medicine, Houston, Texas, USA
| | - Venée N Tubman
- Department of Pediatrics (V.T.), Baylor College of Medicine, Houston, Texas, USA; Texas Children's Cancer and Hematology Centers (V.T.), Houston, Texas, USA.
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26
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Boma PM, Ngimbi SL, Kindundu JM, Wela JI, Ngoie NL, Ngwamah VM, Tshiswaka SM, Monga JK, Panda JM, Bonnechère B. Unveiling mortality risk factors in paediatric sickle cell disease patients during acute crises in the Democratic Republic of the Congo. Blood Cells Mol Dis 2024; 105:102828. [PMID: 38266515 DOI: 10.1016/j.bcmd.2024.102828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
Sickle cell disease (SCD) is a significant health burden in the Democratic Republic of the Congo (DRC). This study aims to identify predictive factors of mortality in SCD children admitted to emergency care in Lubumbashi, DRC. We performed a non-interventional cohort follow-up on SCD patients aged 0 to 16 admitted for a "true emergency". Demographic, clinical, and biological data were collected. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors associated with mortality. Among the 121 patients included, 24 died during the follow-up period. Univariate regression revealed age, Mikobi score, referral origin, stroke, and severe infection as significant risk factors. Multivariate analyses identified Hb, WBC, SR, and LDH as predictive factors of mortality. Notably, patients aged 12 to 16 years faced a higher risk, shifting the age of mortality from early to late childhood and adolescence. This study provides valuable insights into mortality risk factors for paediatric SCD patients during acute crises. Early diagnosis, regular follow-up, and therapeutic education are essential to improve patient outcomes and survival rates. These findings contribute to better disease management and targeted interventions, aiming to reduce mortality associated with SCD.
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Affiliation(s)
- Paul Muteb Boma
- Reference Centre for Sickle Cell Disease of Lubumbashi, Research Institute in Health Sciences, Lubumbashi, Democratic Republic of the Congo
| | | | - Junior Makiese Kindundu
- Reference Centre for Sickle Cell Disease of Lubumbashi, Research Institute in Health Sciences, Lubumbashi, Democratic Republic of the Congo
| | - Jean Israël Wela
- National Institute of Statistics, Kinshasa, Democratic Republic of the Congo
| | - Nathalie Lukanke Ngoie
- Provincial General Reference Hospital Jason Sendwe, Lubumbashi, Democratic Republic of the Congo
| | - Valentin Mukeba Ngwamah
- Reference Centre for Sickle Cell Disease of Lubumbashi, Research Institute in Health Sciences, Lubumbashi, Democratic Republic of the Congo
| | - Sandra Mbuyi Tshiswaka
- Provincial General Reference Hospital Jason Sendwe, Lubumbashi, Democratic Republic of the Congo
| | - Joséphine Kalenga Monga
- Provincial General Reference Hospital Jason Sendwe, Lubumbashi, Democratic Republic of the Congo; Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jules Mulefu Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Research Institute in Health Sciences, Lubumbashi, Democratic Republic of the Congo; Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium; Data Science Institute, University of Hasselt, Diepenbeek, Belgium.
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27
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Santos B, Ginete C, Gonçalves E, Delgadinho M, Miranda A, Faustino P, Arez AP, Brito M. Characterization of a cohort of Angolan children with sickle cell anemia treated with hydroxyurea. Blood Cells Mol Dis 2024; 105:102822. [PMID: 38215581 DOI: 10.1016/j.bcmd.2023.102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Sickle Cell Anemia (SCA) is a monogenic disease, although its severity and response to treatment are very heterogeneous. OBJECTIVES This study aims to characterize a cohort of Angolan children with SCA and evaluate their response to hydroxyurea (HU) treatment and the potential side effects and toxicity. METHODS The study enrolled 215 patients between 3 and 12 years old before and after the administration of HU, at a fix dose of 20 mg/kg/day for 12 months. RESULTS A total of 157 patients started HU medication and 141 of them completed the 12-month treatment. After initiating HU treatment, the frequency of clinical events decreased (transfusions 53.4 %, hospitalizations 47.1 %). The response to HU medication varied among patients, with some experiencing an increase in fetal hemoglobin (HbF) of <5 %. The mean increase in HbF was 11.9 %, ranging from 1.8 % to 31 %. Responders to HU treatment were 57 %, inadequate responders 38.7 % and non-adherent 4.2 %. No clinical side effects related to HU were reported. Hematological toxicities were transient and reversible. Children naïve to HU and with lower HbF reported higher number of hospitalizations caused by malaria infection. During HU treatment, the frequency of malaria episodes did not appear to be affected by HbF levels. CONCLUSIONS the present study provided a valuable contribution to the understanding of the clinical and laboratory profiles of Angolan children with SCA. These findings support the evidence that the implementation of prophylactic measures and treatment with HU is associated with increased survival in children with SCA.
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Affiliation(s)
- Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Angola; Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola; Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Catarina Ginete
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Elisângela Gonçalves
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Mariana Delgadinho
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Armandina Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Paula Faustino
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana Paula Arez
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Miguel Brito
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Angola; H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
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28
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Rarick KR, Li K, Teng RJ, Jing X, Martin DP, Xu H, Jones DW, Hogg N, Hillery CA, Garcia G, Day BW, Naylor S, Pritchard KA. Sterile inflammation induces vasculopathy and chronic lung injury in murine sickle cell disease. Free Radic Biol Med 2024; 215:112-126. [PMID: 38336101 DOI: 10.1016/j.freeradbiomed.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Murine sickle cell disease (SCD) results in damage to multiple organs, likely mediated first by vasculopathy. While the mechanisms inducing vascular damage remain to be determined, nitric oxide bioavailability and sterile inflammation are both considered to play major roles in vasculopathy. Here, we investigate the effects of high mobility group box-1 (HMGB1), a pro-inflammatory damage-associated molecular pattern (DAMP) molecule on endothelial-dependent vasodilation and lung morphometrics, a structural index of damage in sickle (SS) mice. SS mice were treated with either phosphate-buffered saline (PBS), hE-HMGB1-BP, an hE dual-domain peptide that binds and removes HMGB1 from the circulation via the liver, 1-[4-(aminocarbonyl)-2-methylphenyl]-5-[4-(1H-imidazol-1-yl)phenyl]-1H-pyrrole-2-propanoic acid (N6022) or N-acetyl-lysyltyrosylcysteine amide (KYC) for three weeks. Human umbilical vein endothelial cells (HUVEC) were treated with recombinant HMGB1 (r-HMGB1), which increases S-nitrosoglutathione reductase (GSNOR) expression by ∼80%, demonstrating a direct effect of HMGB1 to increase GSNOR. Treatment of SS mice with hE-HMGB1-BP reduced plasma HMGB1 in SS mice to control levels and reduced GSNOR expression in facialis arteries isolated from SS mice by ∼20%. These changes were associated with improved endothelial-dependent vasodilation. Treatment of SS mice with N6022 also improved vasodilation in SS mice suggesting that targeting GSNOR also improves vasodilation. SCD decreased protein nitrosothiols (SNOs) and radial alveolar counts (RAC) and increased GSNOR expression and mean linear intercepts (MLI) in lungs from SS mice. The marked changes in pulmonary morphometrics and GSNOR expression throughout the lung parenchyma in SS mice were improved by treating with either hE-HMGB1-BP or KYC. These data demonstrate that murine SCD induces vasculopathy and chronic lung disease by an HMGB1- and GSNOR-dependent mechanism and suggest that HMGB1 and GSNOR might be effective therapeutic targets for reducing vasculopathy and chronic lung disease in humans with SCD.
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Affiliation(s)
- Kevin R Rarick
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Childrens' Research Institute, Children's Wisconsin, Milwaukee, WI, 53226, USA
| | - Keguo Li
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ru-Jeng Teng
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Childrens' Research Institute, Children's Wisconsin, Milwaukee, WI, 53226, USA
| | - Xigang Jing
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Dustin P Martin
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Hao Xu
- Department of Medicine, Division of Endocrinology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Deron W Jones
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Neil Hogg
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Cheryl A Hillery
- Department of Pediatrics, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Department of Pediatrics, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
| | - Guilherme Garcia
- Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | | | - Kirkwood A Pritchard
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; ReNeuroGen LLC, Milwaukee, WI, 53122, USA; Childrens' Research Institute, Children's Wisconsin, Milwaukee, WI, 53226, USA.
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29
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Gupta P, Goswami SG, Kumari G, Saravanakumar V, Bhargava N, Rai AB, Singh P, Bhoyar RC, Arvinden VR, Gunda P, Jain S, Narayana VK, Deolankar SC, Prasad TSK, Natarajan VT, Scaria V, Singh S, Ramalingam S. Development of pathophysiologically relevant models of sickle cell disease and β-thalassemia for therapeutic studies. Nat Commun 2024; 15:1794. [PMID: 38413594 PMCID: PMC10899644 DOI: 10.1038/s41467-024-46036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Ex vivo cellular system that accurately replicates sickle cell disease and β-thalassemia characteristics is a highly sought-after goal in the field of erythroid biology. In this study, we present the generation of erythroid progenitor lines with sickle cell disease and β-thalassemia mutation using CRISPR/Cas9. The disease cellular models exhibit similar differentiation profiles, globin expression and proteome dynamics as patient-derived hematopoietic stem/progenitor cells. Additionally, these cellular models recapitulate pathological conditions associated with both the diseases. Hydroxyurea and pomalidomide treatment enhanced fetal hemoglobin levels. Notably, we introduce a therapeutic strategy for the above diseases by recapitulating the HPFH3 genotype, which reactivates fetal hemoglobin levels and rescues the disease phenotypes, thus making these lines a valuable platform for studying and developing new therapeutic strategies. Altogether, we demonstrate our disease cellular systems are physiologically relevant and could prove to be indispensable tools for disease modeling, drug screenings and cell and gene therapy-based applications.
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Affiliation(s)
- Pragya Gupta
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sangam Giri Goswami
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Geeta Kumari
- Special Center for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - Vinodh Saravanakumar
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
| | - Nupur Bhargava
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
| | - Akhila Balakrishna Rai
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to Be University), Mangalore, 575018, India
| | - Praveen Singh
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Rahul C Bhoyar
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
| | - V R Arvinden
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Padma Gunda
- Thalassemia and Sickle Cell Society- Kamala Hospital and Research Centre, Shivarampally, Hyderabad, India
| | - Suman Jain
- Thalassemia and Sickle Cell Society- Kamala Hospital and Research Centre, Shivarampally, Hyderabad, India
| | - Vanya Kadla Narayana
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to Be University), Mangalore, 575018, India
| | - Sayali C Deolankar
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to Be University), Mangalore, 575018, India
| | - T S Keshava Prasad
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to Be University), Mangalore, 575018, India
| | - Vivek T Natarajan
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vinod Scaria
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Shailja Singh
- Special Center for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India.
| | - Sivaprakash Ramalingam
- CSIR- Institute for Genomics and Integrative Biology, Mathura Road, Sukhdev Vihar, New Delhi, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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Khargekar N, Banerjee A, Athalye S, Mahajan N, Kargutkar N, Tapase P, Madkaikar M. Role of hydroxyurea therapy in the prevention of organ damage in sickle cell disease: a systematic review and meta-analysis. Syst Rev 2024; 13:60. [PMID: 38331925 PMCID: PMC10851507 DOI: 10.1186/s13643-024-02461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Hydroxyurea is an affordable drug that reduces vaso-occlusive crises and transfusion requirements in sickle cell disease. However, its effectiveness in preventing chronic organ damage is still unclear. This systematic review and meta-analysis aimed to evaluate the role of hydroxyurea in preventing organ morbidity. METHOD We included original articles published in English from 1st January 1990 to 31st January 2023, reporting hydroxyurea therapy and organ damage from PubMed, Google Scholar, Scopus, and CrossRef databases. A total of 45 studies with 4681 sickle cell disease patients were evaluated for organ damage. RESULTS Our analysis showed that hydroxyurea intervention significantly lowered transcranial Doppler and tricuspid regurgitant velocity, with a standardized mean difference of - 1.03 (- 1.49; - 0.58); I 2 = 96% and - 1.37 (CI - 2.31, - 0.42); I 2 = 94%, respectively. Moreover, the pooled estimate for albuminuria showed a beneficial effect post-hydroxyurea therapy by reducing the risk of albuminuria by 58% (risk ratio of 0.42 (0.28; 0.63); I 2 = 28%). CONCLUSION Our study found that a hydroxyurea dose above 20 mg/kg/day with a mean rise in HbF by 18.46% post-hydroxyurea therapy had a beneficial role in reducing transcranial doppler velocity, tricuspid regurgitant velocity, albuminuria, and splenic abnormality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023401187.
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Affiliation(s)
- Naveen Khargekar
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India.
| | - Anindita Banerjee
- Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Shreyasi Athalye
- Department of Transfusion Transmitted Disease, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Namrata Mahajan
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Neha Kargutkar
- Department of Haematogenetics, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Mumbai, Parel, 400 012, India
| | - Prashant Tapase
- Department of Paediatric Immunology & Leukocyte Biology, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400 012, India
| | - Manisha Madkaikar
- Department of Paediatric Immunology & Leukocyte Biology, ICMR-National Institute of Immunohaematology, 13th Floor, New MS Building, KEM Hospital Campus, Parel, Mumbai, 400 012, India
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Peddinti R. Disease-Modifying Therapies for Sickle Cell Disease-An Overview. Pediatr Ann 2024; 53:e52-e55. [PMID: 38302121 DOI: 10.3928/19382359-20231205-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sickle cell disease refers to a group of inherited blood disorders in which hemoglobin polymerization leads to hemolysis and vaso-occlusion. This causes a myriad of complications during a patient's life span, ranging from anemia, infections, and acute and chronic pain to stroke and multiorgan dysfunction. Although there have been dramatic improvements in childhood survival thanks to improved supportive care with penicillin prophylaxis, immunizations, and improved transfusion practices, there was a dearth of disease-modifying therapies, with hydroxyurea being the only medication for >20 years. Here, we discuss the newer therapies for sickle cell disease that have emerged in recent years. [Pediatr Ann. 2024;53(2):e52-e55.].
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Chan KH, Buddharaju R, Idowu M. Real-world experience of patients with sickle cell disease treated with crizanlizumab. J Investig Med 2024; 72:242-247. [PMID: 38073007 DOI: 10.1177/10815589231220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
In 2019, crizanlizumab was approved by the Food and Drug Administration (FDA) to reduce the rate of vaso-occlusive crisis in patients with sickle cell disease (SCD). We aimed to study the real-world effectiveness of crizanlizumab in our comprehensive sickle cell center. This was a retrospective cohort analysis of patients with SCD who received at least two consecutive doses of crizanlizumab. Clinically significant improvement was captured using the patient global impression of change scale (PGI-C). As of December 2022, there were 18 patients eligible for analysis with a median age of 30.5 years. Eight patients had the HbSS genotype, 7 HbSC, and 3 HbSB null genotype. Median duration of exposure to crizanlizumab was 53.6 weeks, and 16 (88.9%) patients received crizanlizumab for ≥26 weeks. Crizanlizumab was very well tolerated with no serious adverse events (grade ≥3) related to treatment. There was no significant difference in laboratory parameters. There was a remarkable improvement in patients' subjective response to crizanlizumab infusion. The median PGI-C score of our patients was 5, signifying moderately better with slight but noticeable changes. The morphine equivalent daily doses (MEDD) were lower after crizanlizumab infusion. MEDD prior to crizanlizumab was 90; after ≥2 consecutive crizanlizumab doses, it was 60. There was also a reduction in the hospital admissions, emergency, and urgent care visit for acute pain crisis in 6 (28%) patients. This study shows that crizanlizumab was associated with improvement in patients' response, both directly and indirectly related to the reduction of opioids used, which is consistent with results from the SUSTAIN trial.
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Affiliation(s)
- Kok Hoe Chan
- Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ruhi Buddharaju
- Department of Medical Education, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Modupe Idowu
- Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Phan V, Park JA, Dulman R, Lewis A, Briere N, Notarangelo B, Yang E. High hydroxyurea usage in sickle cell anemia regardless of patient demographics. Pediatr Blood Cancer 2024; 71:e30728. [PMID: 38069808 DOI: 10.1002/pbc.30728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 12/24/2023]
Abstract
Hydroxyurea is highly effective in sickle cell disease, but it is still underutilized. Reports of hydroxyurea utilization largely use Medicaid data, and socioeconomics is often cited as a barrier. To address whether patient demographics influenced the high hydroxyurea usage rate recently reported for the pediatric sickle cell program of Northern Virginia, analysis of data from 2011 to 2021 revealed no statistical difference in hydroxyurea usage rate between Medicaid and non-Medicaid, African American and African, or age less than 13 and age greater than or equal to 13 years cohorts, demonstrating that hydroxyurea can be successfully implemented across demographic groups.
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Affiliation(s)
- Vivian Phan
- Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Ju Ae Park
- Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Robin Dulman
- Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Angela Lewis
- Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Noravy Briere
- Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | | | - Elizabeth Yang
- Pediatric Specialists of Virginia, Fairfax, Virginia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
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Abdel Razeq NM, Ali RA, Aqel A, Pack-Mabien AV, Sabbah EA, Qadiri IA, Aldasoqi KY. Nurses' Attitudes Concerning Analgesia Administration for Pediatric Patients with Sickle Cell Disease in Jordan: A Cross-Sectional Study. Pain Manag Nurs 2024; 25:e29-e36. [PMID: 37648575 DOI: 10.1016/j.pmn.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 08/05/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Pain management of vaso-occlusive crises is a fundamental priority in the lifelong care of children and adolescents with sickle cell disease. AIM This study examined nurses' attitudes towards caring for children with sickle cell disease (SCD) and SCD pain management in those with vaso-occlusive pain. METHOD A structured, self-reporting survey was provided to a convenience sample of 298 nurses across 10 hospitals serving Jordan's northern and middle regions. Descriptive and inferential statistics were applied for data analysis. RESULTS Most nurses (77%) perceived their experience caring for children with SCD as positive. Many nurses (65%) felt frustrated about caring for these children during painful episodes. Participants identified workload and inadequate time as limiting their ability to address the analgesic needs of children with SCD. Receiving structured education specialized in pain management and more years of experience in nursing significantly predicted less hesitancy in administering opioid-based analgesia. CONCLUSIONS The results of this study provided further insight into factors that potentially contribute to vaso-occlusive pain crises frequently being poorly managed and inadequately addressed among pediatric patients. Nurses' attitudes and understanding of SCD pain management must be addressed to advance the clinical practice of managing pain in children with SCD.
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Affiliation(s)
- Nadin M Abdel Razeq
- The University of Jordan - School of Nursing, Maternal and Child Health Nursing Department, Amman, 11942, Jordan.
| | - Reem A Ali
- Maternal and Child Health Nursing Department, School of Nursing Jordan University of Science and Technology, Irbid, Jordan.
| | - Ahmad Aqel
- Department School of Nursing, The University of Jordan, Amman, Jordan.
| | - Ardie Vanessa Pack-Mabien
- University of South Alabama Health, Johnson Haynes, Jr., MD Comprehensive Sickle Cell Center, 2451 University Hospital Drive, MCSB 1530, Mobile, 36617, Alabama.
| | - Eman Abu Sabbah
- Maternal and Child Health Nursing Department, School of Nursing The University of Jordan, Amman, Jordan.
| | - Inshirah A Qadiri
- Maternal and Child Health Nursing Department, School of Nursing The University of Jordan, Amman, Jordan.
| | - Khadeejeh Y Aldasoqi
- Maternal and Child Health Nursing Department, School of Nursing The University of Jordan, Amman, Jordan.
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35
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Chen M, Hankins JS, Zhang M, Ataga KI. Comparative pharmacovigilance assessment of adverse events associated with the use of hydroxyurea, L-glutamine, voxelotor, and crizanlizumab in sickle cell disease. Am J Hematol 2024; 99:E37-E41. [PMID: 37950855 DOI: 10.1002/ajh.27153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/13/2023]
Abstract
Using disproportionality analysis, this study compared the adverse events (AEs) associated with the use of the new agents (e.g., L-glutamine, voxelotor, and crizanlizumab) to the commonly used medication, hydroxyurea, in sickle cell disease. We found that the most frequent drug-related AEs observed in this real-world study were consistent with those in the HOPE (voxelotor) and SUSTAIN (crizanlizumab) trials, but the rates of AEs were lower. Our study demonstrates that the most common AEs and symptoms of an increased risk associated with the individual drugs varied by treatment. Disproportionate reporting signals of drug-related AEs may also capture information that is independent of subjective measures of patient-reported symptoms. Our study highlights the important need for facilitating patient-physician communication in routine clinical care to understand patient-reported symptoms.
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Affiliation(s)
- Ming Chen
- Institute of Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Min Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Medicine - Hematology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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36
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Lugthart S, Ginete C, Kuona P, Brito M, Inusa BPD. An update review of new therapies in sickle cell disease: the prospects for drug combinations. Expert Opin Pharmacother 2024; 25:157-170. [PMID: 38344818 DOI: 10.1080/14656566.2024.2317336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited disorder characterised by polymerisation of deoxygenated haemoglobin S and microvascular obstruction. The cardinal feature is generalised pain referred to as vaso-occlusive crises (VOC), multi-organ damage and premature death. SCD is the most prevalent inherited life-threatening disorders in the world and over 85% of world's 400,000 annual births occur low-and-middle-income countries. Hydroxyurea remained the only approved disease modifying therapy (1998) until the FDA approved L-glutamine (2017), Crizanlizumab and Voxelotor (2019) and gene therapies (Exa-cel and Lovo-cel, 2023). AREAS COVERED Clinical trials performed in the last 10 years (November 2013 - November 2023) were selected for the review. They were divided according to the mechanisms of drug action. The following pubmed central search terms [sickle cell disease] or [sickle cell anaemia] Hydroxycarbamide/ Hydroxyurea, L-Glutamine, Voxelotor, Crizanlizumab, Mitapivat, Etavopivat, gene therapy, haematopoietic stem cell transplantation, and combination therapy. EXPERT OPINION We recommend future trials of combination therapies for specific complications such as VOCs, chronic pain and renal impairment as well as personalised medicine approach based on phenotype and patient characteristics. Following recent approval of gene therapy for SCD, the challenge is addressing the role of shared decision-making with families, global access and affordability.
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Affiliation(s)
- Sanne Lugthart
- Haematology department, University Hospitals of Bristol and Weston Foundation Trust, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Catarina Ginete
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Patience Kuona
- Child, Adolescent and Women's Health Department, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Miguel Brito
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Baba Psalm Duniya Inusa
- Paediatric Haematology, Evelina London, Guy's and St Thomas NHS Foundation Trust, London
- Women's and Children Academic health, Life Sciences and Medicine, King's College London, London
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García-Morin M, Bardón-Cancho EJ, Beléndez C, Dulín E, Blanco-Soto P, Puertas-López C, Prieto-Medina M, Cervera-Bravo Á, Llorente-Otones L, Pérez-Alonso V, San-Román S, Vecilla-Rivelles C, López-Rubio M, Sebastián E, Bellón JM, Cela E. Madrid Newborn Sickle Cell Disease Cohort: clinical outcomes, stroke prevention and survival. Ann Hematol 2024; 103:373-383. [PMID: 37980280 DOI: 10.1007/s00277-023-05539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
In May 2003, Madrid established the universal newborn screening (NBS) for sickle cell disease (SCD). However, there are no studies resembling the evolution of a SCD neonate cohort followed according to national guidelines in Spain. The aim of this study is to describe the morbimortality and the stroke prevention programme in patients diagnosed by SCD NBS in Madrid. This is a multicentre, observational, prospective cohort study between 2003 and 2018; 187 patients diagnosed with SCD were included (151 HbSS, 6 HbSβ0, 27 HbSC, 3 HbSβ +), and median follow-up was 5.2 years (0.03-14.9). There were 5 deaths: 2 related to SCD in patients with severe genotype (HbSS/HbSβ0). Overall survival reached 95% and SCD-related survival 96.8%. The most frequent events were fever without focus, vaso-occlusive crises and acute chest syndromes. Eight strokes occurred in 5 patients which led to a 90.7% stroke-free survival in severe genotype patients (first stroke rate, 0.54 per 100 patient-years). Transcranial Doppler (TCD) was performed in 95% of eligible patients; 75% of children with pathological TCD remained stroke-free. Regarding HbSS/HbSβ0 patients, 50.1% received hydroxyurea and 9.5% haematopoietic stem cell transplantation. This study reflects the evolution of Madrid SCD cohort and provides morbimortality data similar to other developed countries.
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Affiliation(s)
- Marina García-Morin
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Eduardo J Bardón-Cancho
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain.
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Cristina Beléndez
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Dulín
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Paula Blanco-Soto
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Carolina Puertas-López
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Mar Prieto-Medina
- Nursery, Sickle Cell Disease Newborn Screening, Pediatric Department, Pediatric Oncology/Hematology/BMT Unit, Madrid, Spain
| | - Áurea Cervera-Bravo
- Hematology Unit, Pediatric Department, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Lucía Llorente-Otones
- Hematology Unit, Pediatric Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Vanesa Pérez-Alonso
- Pediatric Oncology and Hematology Unit, Pediatric Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sonsoles San-Román
- Pediatric Oncology and Hematology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Cruz Vecilla-Rivelles
- Hematology Unit, Pediatric Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Montserrat López-Rubio
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Elena Sebastián
- Pediatric Oncology and Hematology Department, Hospital Infantil Niño Jesús, Madrid, Spain
| | - José M Bellón
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Cela
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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Ahmed N, Okany N, Singh D, Rungkitwattanakul D, Weaver SB. Rates of Opioid Misuse Amongst Patients Receiving Pain Management for Sickle Cell Disease in An Urban Setting. J Pharm Pract 2024; 37:104-109. [PMID: 36120980 DOI: 10.1177/08971900221128335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objective: Sickle Cell Disease (SCD) is known to cause acute severe pain episodes known as vaso-occlusive crisis (VOC) mainly treated with opioid analgesics. Since the opioid epidemic there is an interest in determining the opioid misuse potential in these patients. Therefore, the primary objective of this study is to determine the rates of opioid misuse among patients with SCD by assessing the rate of unexpected drug screening results in a sickle cell disease clinic. Methods: This was a retrospective chart review study conducted at the outpatient sickle cell disease clinic. The primary independent variables were the prescribed opioid medications while the primary dependent variable was the collected opioid metabolite. Descriptive statistics, linear regression and multivariate logistic regression analysis were conducted using SPSS version 24. Results: A total of 100 participants were recruited from July 1, 2018, to June 30, 2020 with 71 included in the analysis. The total mean of morphine milligram equivalents (MME) for all participants was 71.1±104.9 with 71% of participants having a daily calculated MME of <90MME. The odds of misusing an opioid were 6.72 times higher (P<.02) if a participant used marijuana compared to a participant who didn't. In addition, the odds of misusing an opioid were 2.47 times higher (P<.04) if the patient was prescribed an opioid daily dose greater than 90 MME as opposed to a daily dose less than 90 MME. Conclusion: Participants who consumed greater than 90 MME's per day and utilized marijuana were more likely to misuse opioids.
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Affiliation(s)
- Nadia Ahmed
- Howard University College of Pharmacy, Clinical Administrative & Pharmacy Sciences, Washington, DC, USA *Students when research was conducted
| | - Nkemjika Okany
- Howard University College of Pharmacy, Clinical Administrative & Pharmacy Sciences, Washington, DC, USA *Students when research was conducted
| | - Divita Singh
- Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Dhakrit Rungkitwattanakul
- Howard University College of Pharmacy, Clinical Administrative & Pharmacy Sciences, Washington, DC, USA *Students when research was conducted
| | - Salome B Weaver
- Howard University College of Pharmacy, Clinical Administrative & Pharmacy Sciences, Washington, DC, USA *Students when research was conducted
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Delgadinho M, Veiga L, Ginete C, Santos B, Miranda A, de Vasconcelos JN, Brito M. Differential expression of adhesion molecules in sickle cell anemia and gut microbiome effect. Ann Hematol 2024; 103:409-419. [PMID: 38153527 PMCID: PMC10799142 DOI: 10.1007/s00277-023-05589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
Sickle cell anemia (SCA) causes a long-standing vascular inflammation state, leading to endothelial dysfunction and chronic overexpression of several adhesion molecules, which contributes to acute and constant vaso-occlusive (VOC) episodes. It has been demonstrated that hydroxyurea (HU) can reduce VOC events, organ damage, blood transfusions, and even the adhesion properties to endothelial cells of SCA subjects. Due to VOC episodes, these patients are also more susceptible to recurrent bacterial translocation and dysbiosis. Given this, our study aimed to uncover the interplay between adhesion molecules, gut microbiome, and hydroxyurea in a population of Angolan SCA children. Serum and fecal samples were obtained before and after HU treatment in 35 children. After HU, four of these adhesion molecules were significantly reduced: sE-selectin (p = 0.002), ADAMTS13 (p = 0.023), sICAM-1 (p = 0.003), and sVCAM-1 (p = 0.018). A positive correlation was observed between the number of neutrophils and sICAM-1, platelets, and sP-selectin, and also between leukocytes, sICAM-1, and sVCAM-1. Most taxa showing a significant correlation mainly belonged to the Clostridiales order. Specifically, from the Clostridium genera, the groups g19, g21, and g34 were all negatively correlated with HbF levels; g19, g21, and g24 positively correlated with leukocytes; g19 positively with neutrophils and sVCAM-1; and g34 positively with E- and P-selectin. Serratia, an opportunistic pathogen, was positively correlated with sE-selectin and sICAM-1 levels. Additionally, a negative correlation was observed between sP-selectin and Bifidobacterium. Research studies in this area could improve our understanding and contribute to finding new prognostic biomarkers to guarantee precise SCA patient stratification and predict severe complications.
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Affiliation(s)
- Mariana Delgadinho
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Luísa Veiga
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Catarina Ginete
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Bengo, Angola
- Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola
| | - Armandina Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | | | - Miguel Brito
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Bengo, Angola.
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Subhahar MB, Karakka Kal AK, Philip M, Muhammed Ajeebsanu M, Karatt TK, Perwad Z. Doping control approach: Identification of equine in vitro metabolites of voxelotor (GBT440), a hemoglobin S polymerization inhibitor. Rapid Commun Mass Spectrom 2024; 38:e9671. [PMID: 38124165 DOI: 10.1002/rcm.9671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023]
Abstract
RATIONALE Sickle cell disease, a debilitating genetic disorder affecting numerous newborns globally, has historically received limited attention in pharmaceutical research. However, recent years have witnessed a notable shift, with the Food and Drug Administration approving three innovative disease-modifying medications. Voxelotor, also known as GBT440, is a promising compound that effectively prevents sickling, providing a safe approach to alleviate chronic hemolytic anemia in sickle cell disease. It is a novel, orally bioavailable small molecule that inhibits hemoglobin S polymerization by enhancing oxygen affinity to hemoglobin. The investigation demonstrated that voxelotor led to an unintended elevation of hemoglobin levels in healthy individuals by increasing serum erythropoietin levels. METHODS Voxelotor and its metabolites in an in vitro setting utilizing equine liver microsomes were discussed. Plausible structures of the identified metabolites were inferred through the application of liquid chromatography in conjunction with high-resolution mass spectrometry. RESULTS Under the experimental conditions, a total of 31 metabolites were detected, including 16 phase I metabolites, two phase II metabolites, and 13 conjugates of phase I metabolites. The principal phase I metabolites were generated through processes such as hydroxylation, reduction, and dissociation. The presence of glucuronide and sulfate conjugates of the parent drug were also observed, along with hydroxylated, reduced, and dissociated analogs. CONCLUSIONS The data acquired will accelerate the identification of voxelotor and related compounds, aiding in the detection of their illicit use in competitive sports. It is crucial to emphasize that the metabolites detailed in this manuscript were identified through in vitro experiments and their detection in an in vivo study may not be guaranteed.
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Affiliation(s)
| | | | - Moses Philip
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | | | - Tajudheen K Karatt
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | - Zubair Perwad
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
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Pinto VM, Gianesin B, Sardo S, Mazzi F, Baiardi G, Menotti S, Piras F, Quintino S, Robello G, Mattioli F, Finco G, Forni GL, De Franceschi L. Safety and efficacy of ketorolac continuous infusion for multimodal analgesia of vaso-occlusive crisis in patients with sickle cell disease. Orphanet J Rare Dis 2024; 19:22. [PMID: 38254184 PMCID: PMC10801952 DOI: 10.1186/s13023-023-02998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Pain is an hallmark of sickle-cell-related acute clinical manifestations as part of acute vaso-occlusive crisis (VOC). In SCD pain has different origins such as vascular or neuropathic pain, which requires multimodal analgesia. This is based on the administration of drugs with different pharmacological mechanisms of action, maximizing analgesia and minimizing their adverse events and the risk of drug-addition in patients experiencing acute-recurrent pain events as in SCD. Ketorolac is a potent non-narcotic analgesic, being relatively safe and effective during pain-management in children and adults. Up to now, there is a lack of safety information on continuous infusion ketorolac as used to control acute pain in patients with SCD, and the benefits/risks ratio needs to be investigated. Here, we report for the first time the safety profile of ketorolac in the special population of patients with SCD. We confirmed that ketorolac in combination with tramadol, an opioid like molecule, is effective in pain control of adult patients with SCD experiencing acute severe VOCs defined by pain visual analog scale. Our study shows that short term (72 h) continuous infusion of ketorolac plus tramadol is not associated with adverse events such as liver or kidney acute disfunction or abnormalities in coagulation parameters during patients' hospitalization and within 30 days after patients discharge. This is extremely important for patients with SCD, who should have access to multimodal therapy to control recurrent acute pain crisis in order to limit central sensitization a fearsome issue of undertreated recurrent acute pain and of chronic pain.
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Affiliation(s)
- Valeria Maria Pinto
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
| | - Barbara Gianesin
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
- For Anemia Foundation, Genoa, Italy
| | - Salvatore Sardo
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Filippo Mazzi
- Department of Medicine, University of Verona and AOUI Verona, Verona, Italy
| | - Giammarco Baiardi
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Genoa, Italy
| | - Sofia Menotti
- Department of Medicine, University of Verona and AOUI Verona, Verona, Italy
| | - Fabio Piras
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genoa, Italy
| | - Sabrina Quintino
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
| | - Giacomo Robello
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
| | - Francesca Mattioli
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Genoa, Italy
| | - Gabriele Finco
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gian Luca Forni
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy.
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Suhail M. Biophysical chemistry behind sickle cell anemia and the mechanism of voxelotor action. Sci Rep 2024; 14:1861. [PMID: 38253605 PMCID: PMC10803371 DOI: 10.1038/s41598-024-52476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
Sickle cell anemia disease has been a great challenge to the world in the present situation. It occurs only due to the polymerization of sickle hemoglobin (HbS) having Pro-Val-Glu typed mutation, while the polymerization does not occur in normal hemoglobin (HbA) having Pro-Glu-Glu peptides. It is also well confirmed that the oxygenated HbS (OHbS) does not participate in the polymerization, while the deoxygenated HbS (dHbS) does, which causes the shape of red blood cells sickled. After polymerization, the blood has a low oxygen affinity. Keeping this fact into consideration, only those drugs are being synthesized that stabilize the OHbS structure so that the polymerization of HbS can be stopped. The literature data showed no systematic description of the changes occurring during the OHbS conversion to dHbS before polymerization. Hence, an innovative reasonable study between HbA and HbS, when they convert into their deoxygenated forms, was done computationally. In this evaluation, physiochemical parameters in HbA/HbS before and after deoxygenation were studied and compared deeply. The computationally collected data was used to understand the abnormal behaviour of dHbS arising due to the replacement of Glu6 with Val6. Consequently, during the presented computational study, the changes occurring in HbS were found opposite/abnormal as compared to HbA after the deoxygenation of both. The mechanism of Voxelotor (GBT-440) action to stop the HbS polymerization was also explained with the help of computationally collected data. Besides, a comparative study between GBT-440 and another suggested drug was also done to know their antisickling strength. Additionally, the effect of pH, CO, CO2, and 2,3-diphosphoglycerate (2,3-DPG) on HbS structure was also studied computationally.
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Affiliation(s)
- Mohd Suhail
- Department of Chemistry, Siddhartha (PG) College, Aakhlor Kheri, Deoband (Saharanpur), Uttar Pradesh, 247554, India.
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Madkhali MA, Abusageah F, Hakami F, Zogel B, Hakami KM, Alfaifi S, Alhazmi E, Zaalah S, Trabi S, Alhazmi AH, Mohrag M, Malhan H. Adherence to Hydroxyurea and Patients' Perceptions of Sickle Cell Disease and Hydroxyurea: A Cross-Sectional Study. Medicina (Kaunas) 2024; 60:124. [PMID: 38256385 PMCID: PMC10819561 DOI: 10.3390/medicina60010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Hydroxyurea is a crucial treatment for sickle cell disease (SCD), but some patients' adherence to it remains suboptimal. Understanding patients' perspectives on SCD and HU is essential for improving adherence. This study aimed to assess hydroxyurea adherence and patients' perceptions of SCD and hydroxyurea among SCD patients in the Jazan region of Saudi Arabia. Materials and Methods: This cross-sectional study collected data from 217 SCD patients using self-administered questionnaires from August 2022 to January 2023. The survey covered patient demographics, SCD consequences, and other clinical data. We used the Brief Illness Perception Questionnaire (B-IPQ) to measure patients' disease perception and the 8-item Morisky Medication Adherence Scale (MMAS-8) to evaluate patients' adherence to HU. Data were analysed using descriptive, t-test, and chi-square tests, and the p-value was set at <0.05 for significance. Results: More than half of the patients were male, with a mean age of 28.09 ± 8.40 years. About 57.6% of the patients were currently using HU. About 81.6% of HU users reported low adherence. The adherence was lower among individuals with infections/recurrent infections and in patients who received repeated blood transfusions. ICU admission, blood transfusion, and certain SCD complications were associated with HU use. Male patients had a higher perception of SCD consequences, concern, and understanding. ICU-admitted and recurrent hospitalized patients had a higher perception of the SCD-related consequences, symptoms, concerns, and emotional responses. Conclusions: HU seems a well-established and efficacious disease-modifying agent, but its underutilization for SCD patients remains challenging. To overcome the adherence challenges, healthcare providers must educate SCD patients about the role of hydroxyurea in lowering disease severity and addressing side effects to obtain maximum benefits. Healthcare providers may consider tailored educational interventions to improve adherence, particularly for patients with infections, recurrent hospitalizations, or repeated blood transfusions. Further research is needed to identify strategies for improving hydroxyurea adherence and patient education among SCD patients.
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Affiliation(s)
- Mohammed Ali Madkhali
- Department of Internal Medicine, Division of Hematology and Oncology, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Faisal Abusageah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Faisal Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Basem Zogel
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Khalid M. Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Samar Alfaifi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Essam Alhazmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Shaden Zaalah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Shadi Trabi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Abdulaziz H. Alhazmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (F.A.); (F.H.); (B.Z.); (K.M.H.); (S.A.) (E.A.); (S.Z.); (S.T.); (A.H.A.)
| | - Mostafa Mohrag
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Hafiz Malhan
- Department of Hematology, Prince Mohammed Bin Nasser Hospital, Jazan 82943, Saudi Arabia;
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Lizarralde-Iragorri MA, Parachalil Gopalan B, Merriweather B, Brooks J, Hill M, Lovins D, Pierre-Charles R, Cullinane A, Dulau-Florea A, Lee DY, Villasmil R, Jeffries N, Shet AS. Isoquercetin for thromboinflammation in sickle cell disease: a randomized double-blind placebo-controlled trial. Blood Adv 2024; 8:172-182. [PMID: 38157227 PMCID: PMC10787266 DOI: 10.1182/bloodadvances.2023011542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Abstract
ABSTRACT Data from a small trial in patients with cancer suggest that isoquercetin (IQ) treatment lowered thrombosis biomarkers and prevented clinical thrombosis, but, to our knowledge, no studies of IQ have been conducted to target thromboinflammation in adults with sickle cell disease (SCD). We conducted a randomized, double-blind, placebo-controlled trial in adults with steady-state SCD (hemoglobin SS [HbSS], HbSβ0thal, HbSβ+thal, or HbSC). The primary outcome was the change in plasma soluble P-selectin (sP-selectin) after treatment compared with baseline, analyzed in the intention-to-treat population. Between November 2019 and July 2022, 46 patients (aged 40 ± 11 years, 56% female, 75% under hydroxyurea treatment) were randomized to receive IQ (n = 23) or placebo (n = 23). IQ was well tolerated and all the adverse events (AEs; n = 21) or serious AEs (n = 14) recorded were not attributable to the study drug. The mean posttreatment change for sP-selectin showed no significant difference between the treatment groups (IQ, 0.10 ± 6.53 vs placebo, 0.74 ± 4.54; P = .64). In patients treated with IQ, whole-blood coagulation (P = .03) and collagen-induced platelet aggregation (P = .03) were significantly reduced from the baseline. Inducible mononuclear cell tissue factor gene expression and plasma protein disulfide isomerase reductase activity were also significantly inhibited (P = .003 and P = .02, respectively). Short-term fixed-dose IQ in patients with SCD was safe with no off-target bleeding and was associated with changes from the baseline in the appropriate direction for several biomarkers of thromboinflammation. The trial was registered at www.clinicaltrials.gov as #NCT04514510.
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Affiliation(s)
- Maria A Lizarralde-Iragorri
- Sickle Thrombosis and Vascular Biology Lab, Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Bindu Parachalil Gopalan
- Sickle Thrombosis and Vascular Biology Lab, Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Brenda Merriweather
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer Brooks
- Office of the Clinical Director, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mai Hill
- Office of the Clinical Director, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Dianna Lovins
- Office of the Clinical Director, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ruth Pierre-Charles
- Office of the Clinical Director, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ann Cullinane
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Alina Dulau-Florea
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Duck-Yeon Lee
- Biochemistry Core Facility, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Rafael Villasmil
- Flow Cytometry Core Facility, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Neal Jeffries
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Arun S Shet
- Sickle Thrombosis and Vascular Biology Lab, Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
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MacEwan SR, Chiang C, O’Brien SH, Creary S, Lin CJ, Hyer JM, Cronin RM. Comparing super-utilizers and lower-utilizers among commercial- and Medicare-insured adults with sickle cell disease. Blood Adv 2024; 8:224-233. [PMID: 37991988 PMCID: PMC10805643 DOI: 10.1182/bloodadvances.2023010813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
ABSTRACT Sickle cell disease (SCD) is a rare but costly condition in the United States. Super-utilizers have been defined as a subset of the population with high health care encounters or expenditures. Although super-utilizers have been described in other disease states, little is known about super-utilizers among adults with SCD. This study aimed to characterize the differences in expenditures, overall health care encounters, and pain episode encounters between super-utilizers (top 10% expenditures) and lower-utilizers with SCD (high, top 10%-24.9%; moderate, 25%-49.9%; and low, bottom 50% expenditures). A retrospective longitudinal cohort of adults with SCD were identified using validated algorithms in MarketScan and Medicare claim databases from 2016 to 2020. Encounters and expenditures were analyzed from inpatient, outpatient, and emergency department settings. Differences in encounters and expenditures between lower-utilizers and super-utilizers were compared using logistic regression. Among super-utilizers, differences in encounters and expenditures were compared according to incidences of pain episode encounters. The study population included 5666 patients with commercial insurance and 8600 with Medicare. Adjusted total annual health care expenditure was 43.46 times higher for super-utilizers than for low-utilizers among commercial-insured and 13.37 times higher in Medicare-insured patients. Among super-utilizers, there were patients with few pain episode encounters who had higher outpatient expenditures than patients with a high number of pain episode encounters. Our findings demonstrate the contribution of expensive outpatient care among SCD super-utilizers, in which analyses of high expenditure have largely focused on short-term care. Future studies are needed to better understand super-utilizers in the SCD population to inform the effective use of preventive interventions and/or curative therapies.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH
| | - ChienWei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Clinical and Translational Science, The Ohio State University, Columbus, OH
| | - Sarah H. O’Brien
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Susan Creary
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | | | - J. Madison Hyer
- Secondary Data Core, Center for Clinical and Translational Science, The Ohio State University, Columbus, OH
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Robert M. Cronin
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH
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Abdulrehman J, Forté S, Tomlinson G, Solh Z, Bolster L, Sun HL, Bartolucci P, Kuo KHM. THromboprophylaxis In Sickle Cell Disease with central venous catheters (THIS): an internal pilot randomised controlled trial protocol. BMJ Open 2024; 14:e079363. [PMID: 38171625 PMCID: PMC10773310 DOI: 10.1136/bmjopen-2023-079363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Individuals with sickle cell disease (SCD) and central venous catheters (CVC) are at high risk for venous thromboembolism (VTE). Minimal data exist regarding the use of anticoagulation as thromboprophylaxis of VTE in this demographic, and as a result, clinical equipoise exists. Prophylactic dose rivaroxaban, a direct oral anticoagulant, is efficacious and safe as thromboprophylaxis in other demographics, and may be an optimal agent in SCD with CVC. Prior to conducting a full clinical trial to assess rivaroxaban as thromboprophylaxis in SCD with CVC, a pilot study is needed to gauge its feasibility. METHODS AND ANALYSIS THromboprophylaxis In Sickle Cell Disease pilot trial is an investigator-initiated, multicentre, double-blinded, randomised controlled trial (RCT) assessing if it is feasible and safe to conduct an adequately powered RCT comparing rivaroxaban to matching placebo as thromboprophylaxis in those with SCD and CVC. Fifty adult patients with SCD and CVC will be randomised to receive either rivaroxaban 10 mg daily or matching placebo for the duration of the CVC in situ for up to 1 year. After randomisation, follow-up visits will occur every 3 months. The primary outcomes pertain to the feasibility of a full trial and include numbers of eligible and recruited participants. Exploratory outcomes include overall incidence of VTE and bleeding complications, as well as quality of life. If the full trial is feasible, blinding will be maintained and patients in the pilot study will be included in the full trial. ETHICS AND DISSEMINATION The trial was initially approved by the University Health Network Research Ethics Board (REB) in Toronto, Canada. All sites will obtain approval from their respective REB prior to commencement of study activities. Study results will be disseminated through presentations at medical conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05033314.
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Affiliation(s)
- Jameel Abdulrehman
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Forté
- Division of Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - George Tomlinson
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ziad Solh
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lauren Bolster
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pablo Bartolucci
- Department of Internal Medicine, Assistance Publique Hopitaux de Paris, Creteil, France
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Fouda RT, Cherukury HM, Kiven SB, Garcia NR, Argueta DA, Velasco GJ, Gupta K, Roberts JD. Colchicine reduces inflammation in a humanized transgenic murine model of sickle cell disease. Haematologica 2024; 109:308-311. [PMID: 37534545 PMCID: PMC10772532 DOI: 10.3324/haematol.2023.283377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023] Open
Abstract
Not available.
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Affiliation(s)
- Raghda T Fouda
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
| | - Hemanth M Cherukury
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
| | - Stacy B Kiven
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
| | - Natalie R Garcia
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
| | - Donovan A Argueta
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
| | - Graham J Velasco
- Pathology Department, VA Long Beach Medical Center, Long Beach, CA
| | - Kalpna Gupta
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN.
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Seidl E, Wilson D, Odame I, Kirby-Allen M, Grasemann H. Lung function decline in children with sickle cell disease treated with hydroxyurea. Am J Hematol 2024; 99:E19-E21. [PMID: 37859529 DOI: 10.1002/ajh.27134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Elias Seidl
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - David Wilson
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Isaac Odame
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, Toronto, Canada
| | - Melanie Kirby-Allen
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, Toronto, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
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Hamdy M, El-Beshlawy A, Veríssimo MPA, Kanter J, Inusa B, Williams S, Lee D, Temin NT, Fradette C, Tricta F, Ebeid FSE, Kwiatkowski JL, Elalfy MS. Deferiprone versus deferoxamine for transfusional iron overload in sickle cell disease and other anemias: Pediatric subgroup analysis of the randomized, open-label FIRST study. Pediatr Blood Cancer 2024; 71:e30711. [PMID: 37807937 DOI: 10.1002/pbc.30711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Children with sickle cell disease (SCD) who are chronically transfused often, require iron chelation therapy. There are limited data that allow for comparison of the efficacy and safety of the iron chelator deferiprone versus deferoxamine in children with SCD. METHODS This post hoc analysis of the phase 3b/4, randomized, open-label FIRST (Ferriprox in Patients with IRon Overload in Sickle Cell Disease Trial) study (NCT02041299) included patients 17 years and younger with SCD or other anemias receiving deferiprone or deferoxamine. RESULTS Overall, 142 patients were evaluated; mean ages were 10.5 and 11.7 years in the deferiprone and deferoxamine groups, respectively. At 12 months: mean change from baseline in liver iron concentration was -3.3 mg/g dry weight (dw) with deferiprone and -3.4 mg/g dw with deferoxamine (p = .8216); relative mean change (coefficient of variation %) in log cardiac T2* magnetic resonance imaging was 1.02 (21.8%) with deferiprone and 0.95 (19.5%) with deferoxamine (p = .0717); and the mean (standard error) change in serum ferritin levels was -133.0 (200.3) μg/L with deferiprone and -467.1 (244.1) μg/L with deferoxamine (p = .2924). The most common deferiprone-related adverse events (AEs) were upper abdominal pain (20.2%), vomiting (13.8%), pyrexia (9.6%), decreased neutrophil count (9.6%), increased alanine aminotransferase (ALT; 9.6%), and increased aspartate aminotransferase (AST; 9.6%). All cases of increased ALT, increased AST, and neutropenia resolved, most without intervention. CONCLUSIONS This post hoc analysis of pediatric patients from FIRST corroborated previous findings in adults that deferiprone is comparable to deferoxamine in reducing iron overload. No new safety concerns were observed. Deferiprone is an oral chelation option that could improve adherence and outcomes in children.
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Affiliation(s)
- Mona Hamdy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal El-Beshlawy
- Department of Pediatric Hematology, Pediatric Hospital of Cairo University, Cairo, Egypt
| | | | - Julie Kanter
- Division of Hematology and Oncology, Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Baba Inusa
- Paediatric Haematology, Evelina Children's Hospital, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Suzan Williams
- Department of Haematology and Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Lee
- Hematology/Immunology Program, Chiesi Canada Corporation, Toronto, Ontario, Canada
| | - Noemi Toiber Temin
- Hematology/Immunology Program, Chiesi Canada Corporation, Toronto, Ontario, Canada
| | - Caroline Fradette
- Hematology/Immunology Program, Chiesi Canada Corporation, Toronto, Ontario, Canada
| | - Fernando Tricta
- Hematology/Immunology Program, Chiesi Canada Corporation, Toronto, Ontario, Canada
| | - Fatma S E Ebeid
- Pediatric Hematology Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Janet L Kwiatkowski
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohsen S Elalfy
- Pediatric Hematology Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Harris EM, Donado C, Archer NM. Reply to: Comment on: Ketamine use for management of vaso-occlusive pain in pediatric sickle cell disease. Pediatr Blood Cancer 2024; 71:e30740. [PMID: 37877853 DOI: 10.1002/pbc.30740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Emily M Harris
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carolina Donado
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Natasha M Archer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA
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