Trusted Resources: Evidence & Education
Scientific literature and patient education texts
Novel use of Hydroxyurea in an African Region with Malaria (NOHARM): a trial for children with sickle cell anemia
source: Blood
year: 2017
authors: Opoka R.O, Ndugwa C.M, Latham T.S, Lane A, Hume H.A, Kasirye P, Hodges J.S, Ware R.E, John C.C
summary/abstract:Hydroxyurea treatment is recommended for children with sickle cell anemia (SCA) living in high-resource malaria-free regions, but its safety and efficacy in malaria-endemic sub-Saharan Africa, where the greatest sickle cell burden exists, remain unknown. In vitro studies suggest hydroxyurea could increase malaria severity, and hydroxyurea-associated neutropenia could worsen infections. NOHARM was a randomized, double-blinded, placebo-controlled trial conducted in malaria-endemic Uganda, comparing hydroxyurea to placebo at 20 ± 2.5 mg/kg/day for 12 months. The primary outcome was incidence of clinical malaria. Secondary outcomes included SCA-related adverse events, clinical and laboratory effects, and hematological toxicities. Children received either hydroxyurea (N=104) or placebo (N=103). Malaria incidence did not differ between children on hydroxyurea [0.05 episodes/child/year, 95% CI (0.02, 0.13)] versus placebo [0.07 episodes/child/year (0.03, 0.16)]; the hydroxyurea/placebo malaria incidence rate ratio was 0.7 [(0.2, 2.7), p=0.61].
Time to infection also did not differ significantly between treatment arms. A composite SCA-related clinical outcome (vaso-occlusive painful crisis, dactylitis, acute chest syndrome, splenic sequestration, or blood transfusion) was less frequent with hydroxyurea (45%) than placebo (69%, p=0.001). Children receiving hydroxyurea had significantly increased hemoglobin concentration and fetal hemoglobin, with decreased leukocytes and reticulocytes. Serious adverse events, sepsis episodes, and dose-limiting toxicities were similar between treatment arms. Three deaths occurred (two hydroxyurea, one placebo, none from malaria). Hydroxyurea treatment appears safe for children with SCA living in malaria-endemic sub-Saharan Africa, without increased severe malaria, infections, or adverse events. Hydroxyurea provides SCA-related laboratory and clinical efficacy, but optimal dosing and monitoring regimens for Africa remain undefined.
organization: Makerere University, Kampala, Uganda; Cincinnati Children's Hospital Medical Center, Cincinnati, United States; Universite de Montreal Service d'Hematologie/Oncologie, Montreal, Canada; University of Minnesota, Minneapolis, United States; Cincinnati Children's Hospital Medical Center, Cincinnati, United States; University of Indiana, Indianapolis, United StatesDOI: 10.1182/blood-2017-06-788935
read more full text
Related Content
-
Improving vaso-occlusive crisis (VOC) management for those living with sickle cell diseaseThe Sickle Cell Disease Council For CHAN...
-
FDA Approves Hydroxyurea Tablets for Pediatric Patients With Sickle Cell AnemiaThe US Food and Drug Administration (FDA...
-
Effects of Rifaximin on Circulating Aged Neutrophils in Sickle Cell DiseaseThere is a large therapeutic gap in sick...
-
Acetylon Presents Preclinical Data Demonstrating the Utility of Selective HDAC1,2 Inhibition by ACY-957 to Induce Ga...Acetylon Pharmaceuticals, Inc., the lead...
-
Sickle Cell Breakthrough: Shauna’s Storyhttps://www.youtube.com/watch?v=Q-kXWV-s...
-
A Teenager’s Breakthrough Gene Therapy for Sickle Cell DiseaseMeet Helen Obando, a shy 16-year-old who...
-
Gene therapy targets sickle-cell diseaseElliott Vichinsky estimates that at leas...
Don’t forget to join the oneSCDvoice community!
To improve your experience on this site, we use cookies. This includes cookies essential for the basic functioning of our website, cookies for analytics purposes, and cookies enabling us to personalize site content. By clicking on 'Accept' or any content on this site, you agree that cookies can be placed. You may adjust your browser's cookie settings to suit your preferences. More Information
The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.