Perspectives

CME Article: Medical Neglect by Underprescription and Underutilization of Hydroxyurea in Children with Sickle Cell Disease

Authors: Sohail Rana, MD

Abstract

More than 20 years ago, I prescribed hydroxyurea (HU) for the first time. Derrick was 17 and had been admitted more than 50 times for severe pain crises. Brought in severe pain to the hospital by ambulance, he would receive intravenous fluids and narcotics for several days and then finally be able to walk and be discharged home. He would miss more than a week of school with each episode, and he was two grades behind because of repeated hospitalizations. Following the publication of the Multicenter Study of Hydroxyurea (MSH)1 results, I prescribed HU for Derrick. I did not see Derrick for several months; he had not been admitted and I wondered if he ever started taking HU. At the next visit he was looking well and reported that he had not had any pain and had not missed any days of school. I studied him for the next 2 years; he was never admitted during that time and he graduated from high school.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Charache S, Terrin ML, Moore RD, et al. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med 1995;332:1317-1322.
 
2. Zhang D, Xu C, Manwani D, et al. Neutrophils, platelets, and inflammatory pathways at the nexus of sickle cell disease pathophysiology. Blood 2016;127:801-809.
 
3. Adams-Graves P, Bronte-Jordan L. Recent treatment guidelines for managing adult patients with sickle cell disease: challenges in access to care, social issues, and adherence. Expert Rev Hematol 2016;9:541-552.
 
4. DeBaun MR, Kirkham FJ. Central nervous system complications and management in sickle cell disease. Blood 2016;127:829-838.
 
5. Drazen CH, Abel R, Gabir M, et al. Prevalence of developmental delay and contributing factors among children with sickle cell disease. Pediatr Blood Cancer 2016;63:504-10.
 
6. Cancio MI, Helton KJ, Schreiber JE, et al. Silent cerebral infarcts in very young children with sickle cell anaemia are associated with a higher risk of stroke. Br J Haematol 2015;171:120-129.
 
7. Mackin RS, Insel P, Truran D, et al. Neuroimaging abnormalities in adults with sickle cell anemia: associations with cognition. Neurology 2014;82:835-841.
 
8. Epping AS, Myrvik MP, Newby RF, et al. Academic attainment findings in children with sickle cell disease. J Sch Health 2013;83:548-553.
 
9. Vichinsky EP, Neumayr LD, Gold JI, et al. Neuropsychological dysfunction and neuroimaging abnormalities in neurologically intact adults with sickle cell anemia. JAMA 2010;303:1823-1831.
 
10. Glass P, Brennan T, Wang J, et al. Neurodevelopmental deficits among infants and toddlers with sickle cell disease. J Dev Behav Pediatr 2013;34:399-405.
 
11. Armstrong FD, Elkin TD, Brown RC, et al. Developmental function in toddlers with sickle cell anemia. Pediatrics 2013;131:e406-e414.
 
12. Armstrong-Wells J, Grimes B, Sidney S, et al. Utilization of TCD screening for primary stroke prevention in children with sickle cell disease. Neurology 2009;72:1316-1321.
 
13. Kratovil T, Bulas D, Driscoll MC, et al. Hydroxyurea therapy lowers TCD velocities in children with sickle cell disease. Pediatr Blood Cancer 2006;47:894-900.
 
14. Kawadler JM, Kirkham FJ, Clayden JD, et al. White matter damage relates to oxygen saturation in children with sickle cell anemia without silent cerebral infarcts. Stroke 2015;46:1793-1799.
 
15. Edwards CL, Raynor RD, Feliu M, et al. Neuropsychological assessment, neuroimaging, and neuropsychiatric evaluation in pediatric and adult patients with sickle cell disease (SCD). Neuropsychiatr Dis Treat 2007;3:705-709.
 
16. Steinberg MH, McCarthy WF, Castro O, et al. The risks and benefits of long-term use of hydroxyurea in sickle cell anemia: a 17.5 year follow-up. Am J Hematol 2010;85:403-408.
 
17. Wang WC, Ware RE, Miller ST, et al. Hydroxycarbamide in very young children with sickle-cell anaemia: a multicentre, randomised, controlled trial (BABY HUG). Lancet 2011;377:1663-1672.
 
18. Lê PQ, Gulbis B, Dedeken L, et al. Survival among children and adults with sickle cell disease in Belgium: benefit from hydroxyurea treatment. Pediatr Blood Cancer 2015;62:1956-1961.
 
19. Lobo CL, Pinto JF, Nascimento EM, et al. The effect of hydroxcarbamide therapy on survival of children with sickle cell disease. Br J Haematol 2013;161:852-860.
 
20. Lagunju I, Brown BJ, Sodeinde O. Hydroxyurea lowers transcranial Doppler flow velocities in children with sickle cell anaemia in a Nigerian cohort. Pediatr Blood Cancer 2015;62:1587-1591.
 
21. Ware RE, Davis BR, Schultz WH, et al. Hydroxycarbamide versus chronic transfusion for maintenance of transcranial Doppler flow velocities in children with sickle cell anaemia-TCD With Transfusions Changing to Hydroxyurea (TWiTCH): a multicentre, open-label, phase 3, non-inferiority trial. Lancet 2016;387:661-670.
 
22. Helton KJ, Adams RJ, Kesler KL, et al. Magnetic resonance imaging/angiography and transcranial Doppler velocities in sickle cell anemia: results from the SWiTCH trial. Blood 2014;124:891-898.
 
23. Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA 2014;312:1033-1048.
 
24. Stettler N, McKiernan CM, Melin CQ, et al. Proportion of adults with sickle cell anemia and pain crises receiving hydroxyurea. JAMA 2015;313:1671-1672.