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Abdullahi SU, Sunusi S, Aminu H, Umar R, Abba MS, Jibir BW, Sani S, Gambo S, Bello-Manga H, Galadanci NA, Covert Greene B, Kassim AA, Jordan LC, Aliyu MH, Rodeghier M, DeBaun MR, Volanakis EJ. Transcranial doppler velocity in iron-deficient Nigerian children with sickle cell anemia. Am J Hematol 2024; 99:797-799. [PMID: 38323371 DOI: 10.1002/ajh.27230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 02/08/2024]
Abstract
Oral iron supplementation in iron deficient children with sickle cell anemia and normal transcranial Doppler ultrasound (TCD) velocities does not reduce arterial flow in the middle cerebral artery.
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Affiliation(s)
- Shehu Umar Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Surayya Sunusi
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hauwa Aminu
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rashida Umar
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Saifuddeen Sani
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Halima Bello-Manga
- Department of Hematology and Blood Transfusion, Barau-Dikko Teaching Hospital, Kaduna, Nigeria
| | - Najibah A Galadanci
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brittany Covert Greene
- Department of Pediatrics, Vanderbilt-Meharry-Matthew Walker Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Department of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lori C Jordan
- Department of Pediatrics, Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
| | | | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry-Matthew Walker Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emmanuel J Volanakis
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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2
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Drown L, Osei M, Thapa A, Boudreaux C, Archer N, Bukhman G, Adler AJ. Models of care for sickle cell disease in low-income and lower-middle-income countries: a scoping review. Lancet Haematol 2024; 11:e299-e308. [PMID: 38432241 DOI: 10.1016/s2352-3026(24)00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
Sickle cell disease has a growing global burden falling primarily on low-income countries (LICs) and lower-middle-income countries (LMICs) where comprehensive care is often insufficient, particularly in rural areas. Integrated care models might be beneficial for improving access to care in areas with human resource and infrastructure constraints. As part of the Centre for Integration Science's ongoing efforts to define, systematise, and implement integrated care delivery models for non-communicable diseases (NCDs), this Review explores models of care for sickle cell disease in LICs and LMICs. We identified 99 models from 136 studies, primarily done in tertiary, urban facilities in LMICs. Except for two models of integrated care for concurrent treatment of other conditions, sickle cell disease care was mostly provided in specialised clinics, which are low in number and accessibility. The scarcity of published evidence of models of care for sickle cell disease and integrated care in rural settings of LICs and LMICs shows a need to implement more integrated models to improve access, particularly in rural areas. PEN-Plus, a model of decentralised, integrated care for severe chronic non-communicable diseases, provides an approach to service integration that could fill gaps in access to comprehensive sickle cell disease care in LICs and LMICs.
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Affiliation(s)
- Laura Drown
- Center for Integration Science in Global Health Equity, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Miriam Osei
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ada Thapa
- Center for Integration Science in Global Health Equity, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chantelle Boudreaux
- Center for Integration Science in Global Health Equity, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Natasha Archer
- Harvard Medical School, Harvard University, Boston, MA, USA; Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Gene Bukhman
- Center for Integration Science in Global Health Equity, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alma J Adler
- Center for Integration Science in Global Health Equity, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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3
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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] [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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4
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Segbefia C, Campbell J, Tartaglione I, Asare EV, Andemariam B, Zempsky W, Colombatti R, Boatemaa GD, Boruchov D, Rao S, Piccone CM, Smith A, Haile H, Kim E, Wilson S, Farooq F, Urbonya R, Rivers A, Manwani D, Gai J, Sey F, Inusa B, Antwi-Boasiako C, Strunk C, Campbell AD. Pain Frequency and Health Care Utilization Patterns in Women with Sickle Cell Disease Experiencing Menstruation-Associated Pain Crises. J Womens Health (Larchmt) 2023; 32:1284-1291. [PMID: 38011013 DOI: 10.1089/jwh.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: Pain crises in sickle cell disease (SCD) lead to high rates of health care utilization. Historically, women have reported higher pain burdens than men, with recent studies showing a temporal association between pain crisis and menstruation. However, health care utilization patterns of SCD women with menstruation-associated pain crises have not been reported. We studied the frequency, severity, and health care utilization of menstruation-associated pain crises in SCD women. Materials and Methods: A multinational, cross-sectional cohort study of the SCD phenotype was executed using a validated questionnaire and medical chart review from the Consortium for the Advancement of Sickle Cell Research (CASiRe) cohort. Total number of pain crises, emergency room/day hospital visits, and hospitalizations were collected from a subcohort of 178 SCD women within the past 6 months and previous year. Results: Thirty-nine percent of women reported menstruation-associated pain crises in their lifetime. These women were significantly more likely to be hospitalized compared with those who did not (mean 1.70 vs. 0.67, p = 0.0005). Women reporting menstruation-associated pain crises in the past 6 months also experienced increased hospitalizations compared with those who did not (mean 1.71 vs. 0.75, p = 0.0016). Forty percent of women reported at least four menstruation-associated pain crises in the past 6 months. Conclusions: Nearly 40% of SCD women have menstruation-associated pain crises. Menstruation-associated pain crises are associated with high pain burden and increased rates of hospitalization. Strategies are needed to address health care disparities within gynecologic care in SCD.
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Affiliation(s)
- Catherine Segbefia
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Jillian Campbell
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Immacolata Tartaglione
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Biree Andemariam
- Division of Hematology-Oncology, New England Sickle Cell Institute, Neag Comprehensive Cancer Center, University of Connecticut, Farmington, Connecticut, USA
| | - William Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Raffaella Colombatti
- Department of Women's and Child Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Gifty Dankwah Boatemaa
- Department of Physiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Donna Boruchov
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Sudha Rao
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Connie M Piccone
- Department of Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Ashya Smith
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Haikel Haile
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Esther Kim
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samuel Wilson
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Fatimah Farooq
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebekah Urbonya
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Rivers
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Jiaxiang Gai
- Division of Biostatistics and Study Methodology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Fredericka Sey
- Ghana Institute of Clinical Genetics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Baba Inusa
- Department of Pediatric Haematology, Evelina Children's Hospital, Guy's and St. Thomas NHS Trust, College of Nursing, London, United Kingdom
| | - Charles Antwi-Boasiako
- Department of Physiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
- College of Health Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Crawford Strunk
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew D Campbell
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Hematology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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5
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Janas AM, Barry M, Lee S. Epidemiology, causes, and morbidities of stroke in the young. Curr Opin Pediatr 2023; 35:641-647. [PMID: 37779483 DOI: 10.1097/mop.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW The purpose is to describe the latest research on epidemiology, causes, and morbidities of stroke in neonates and children. RECENT FINDINGS The global incidence of childhood stroke is approximately 2 per 100 000 person-years, which is significantly lower compared to neonates (20-40 per 100 000 live births) and adults (80-90 per 100 000 person-years). Placental abnormalities are a risk factor for perinatal stroke, although cause is usually multifactorial. In children, nonatherosclerotic arteriopathies and arteriovenous malformations are major causes of ischemic and hemorrhagic strokes, respectively. The perinatal period confers a high risk of stroke and can lead to long-term disability, including motor delay, cognitive or speech impairment, and epilepsy. Recent studies suggest that at least 50% of survivors of perinatal stroke have abnormal neurodevelopmental scores in long-term follow up. Childhood stroke is associated with significant morbidity, including epilepsy, motor impairments, and behavioral disability. Recent studies have also identified an association between pediatric stroke and behavioral disorders, such as attention deficit hyperactivity disorder and autism. SUMMARY Perinatal and childhood strokes are important causes of neurological morbidity. Given the low incidence of childhood stroke, prospective research studies on epidemiology, causes, and outcomes remain limited, highlighting the need for continued multisite collaborations.
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Affiliation(s)
- Anna M Janas
- University of Colorado School of Medicine, Department of Pediatrics, Section of Pediatric Critical Care Medicine
| | - Megan Barry
- University of Colorado School of Medicine, Department of Pediatrics, Section of Child Neurology, Aurora, Colorado
| | - Sarah Lee
- Stanford University School of Medicine, Department of Neurology, Divisions of Child Neurology and Stroke, Palo Alto, California, USA
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Pizzo A, Porter JS, Carroll Y, Burcheri A, Smeltzer MP, Beestrum M, Nwosu C, Badawy S, Hankins JS, Klesges LM, Alberts NM. Provider prescription of hydroxyurea in youth and adults with sickle cell disease: A review of prescription barriers and facilitators. Br J Haematol 2023; 203:712-721. [PMID: 37691131 PMCID: PMC11057211 DOI: 10.1111/bjh.19099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Sickle cell disease (SCD) is an inherited red blood cell disorder associated with frequent painful events and organ damage. Hydroxyurea (HU) is the recommended evidence-based treatment of SCD. However, among patients eligible for HU, prescription rates are low. Utilizing a scoping review approach, we summarized and synthesized relevant findings regarding provider barriers and facilitators to the prescription of HU in youth and adults with SCD and provided suggestions for future implementation strategies to improve prescription rates. Relevant databases were searched using specified search terms. Articles reporting provider barriers and/or facilitators to prescribing HU were included. A total of 10 studies met the inclusion criteria. Common barriers to the prescription of HU identified by providers included: doubts around patients' adherence to HU and their engaging in required testing, concerns about side effects, lack of knowledge, cost and patient concerns about side effects. Facilitators to the prescription of HU included beliefs in the effectiveness of HU, provider demographics and knowledge. Findings suggest significant provider biases exist, particularly in the form of negative perceptions towards patients' ability to adhere to taking HU and engaging in the required follow-up. Improving provider knowledge and attitudes towards HU and SCD may help improve low prescription rates.
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Affiliation(s)
- Alex Pizzo
- Department of Psychology, Concordia University, Montreal,
QC
| | - Jerlym S. Porter
- Department of Psychology and Biobehavioral Sciences, St.
Jude Children’s Research Hospital, Memphis, TN
| | - Yvonne Carroll
- Department of Hematology, St. Jude Children’s
Research Hospital, Memphis, TN
| | - Adam Burcheri
- Department of Psychology, Concordia University, Montreal,
QC
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental
Health, University of Memphis, Memphis, TN
| | - Molly Beestrum
- Department of Pediatrics, Northwestern University Feinberg
School of Medicine, Chicago, IL
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children’s
Research Hospital, Memphis, TN
| | - Sherif Badawy
- Department of Pediatrics, Northwestern University Feinberg
School of Medicine, Chicago, IL
- Division of Hematology, Oncology, and Stem Cell Transplant,
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s
Research Hospital, Memphis, TN
- Global Pediatric Medicine, St. Jude Children’s
Research Hospital, Memphis, TN
| | - Lisa M. Klesges
- Division of Public Health Sciences, Department of Surgery,
Washington University Medical School, St. Louis, MO
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Arji EE, Eze UJ, Ezenwaka GO, Kennedy N. Evidence-based interventions for reducing sickle cell disease-associated morbidity and mortality in sub-Saharan Africa: A scoping review. SAGE Open Med 2023; 11:20503121231197866. [PMID: 37719166 PMCID: PMC10504846 DOI: 10.1177/20503121231197866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023] Open
Abstract
Objective Sickle cell disease is a lifelong illness affecting millions of people globally, but predominantly burdensome in sub-Saharan Africa, where most affected children do not live to adulthood, despite available evidence-based interventions that reduce the disease burden in high-income countries. Method We reviewed studies evaluating evidence-based interventions that decrease sickle cell disease-related morbidity and mortality among children living in sub-Saharan Africa. We used the Joanna Briggs scoping review methodological framework and grouped identified evidence-based interventions into preventative pharmacotherapeutic agents, newborn screening and comprehensive healthcare, disease-modifying agents, nutritional supplementation, systemic treatment, supportive agents and patient/carer/population education. Results We included 36 studies: 18 randomized controlled trials, 11 observational studies, 5 before-and-after studies and 2 economic evaluation studies, with most of the studies performed in West African countries. Included studies suggest evidence-based interventions effectively to reduce the common morbidities associated with sickle cell disease such as stroke, vaso-occlusive crisis, acute chest syndrome, severe anaemia and malaria infection. Evidence-based interventions also improve survival among study participants. Specifically, our review shows hydroxyurea increases haemoglobin and foetal haemoglobin levels, a finding with practical implications given the challenges with blood transfusion in this setting. The feasibility of implementing individual interventions is hampered by challenges such as affordability, accessibility and the availability of financial and human resources. Conclusion Our review suggests that regular use of low-dose hydroxyurea therapy, sulphadoxine-pyrimethamine chemoprophylaxis, L-arginine and Omega-3 fatty acid supplementation and establishment of specialist stand-alone sickle cell clinics could reduce the sickle cell disease-associated morbidity and mortality in sub-Saharan Africa countries.
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Affiliation(s)
- Emmanuel Emenike Arji
- School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, UK
| | - Ujunwa Justina Eze
- Department of Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, PA, USA
| | - Gloria Oluchukwu Ezenwaka
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria
| | - Neil Kennedy
- School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, UK
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8
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Ambrose EE, Latham TS, Songoro P, Charles M, Lane AC, Stuber SE, Makubi AN, Ware RE, Smart LR. Hydroxyurea with dose escalation for primary stroke risk reduction in children with sickle cell anaemia in Tanzania (SPHERE): an open-label, phase 2 trial. Lancet Haematol 2023; 10:e261-e271. [PMID: 36870358 PMCID: PMC10132280 DOI: 10.1016/s2352-3026(22)00405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND Transcranial Doppler screening with chronic transfusions reduces stroke risk in children with sickle cell anaemia but is not feasible in low-resource settings. Hydroxyurea is an alternative treatment to decrease stroke risk. We aimed to estimate stroke risk in children with sickle cell anaemia in Tanzania and to determine the efficacy of hydroxyurea to decrease and prevent stroke. METHODS We did an open-label, phase 2 trial (SPHERE) at Bugando Medical Centre, Mwanza, Tanzania. Children aged 2-16 years with a diagnosis of sickle cell anaemia confirmed by haemoglobin electrophoresis were eligible for enrolment. Participants had transcranial Doppler ultrasound screening by a local examiner. Participants with elevated Doppler velocities, either conditional (170-199 cm/s) or abnormal (≥200 cm/s), received oral hydroxyurea starting at 20 mg/kg once daily and escalated every 8 weeks by 5 mg/kg per day to the maximum tolerated dose. Participants with normal Doppler velocities (<170 cm/s) received usual care from the sickle cell anaemia clinic and were rescreened after 12 months to determine whether they qualified for treatment on trial. The primary endpoint was change in transcranial Doppler velocity from the baseline visit to after 12 months of hydroxyurea treatment, analysed in all patients who had paired baseline and follow-up measurements collected after 12 months of treatment. Safety was analysed in the per-protocol population (all participants who received study treatment). This study is registered with ClinicalTrials.gov, NCT03948867. FINDINGS Between April 24, 2019, and April 9, 2020, 202 children were enrolled and had transcranial Doppler screening. Sickle cell anaemia was confirmed by DNA-based testing in 196 participants (mean age 6·8 years [SD 3·5], 103 [53%] were female, and 93 [47%] were male). At the baseline screening, 47 (24%) of 196 participants had elevated transcranial Doppler velocities (43 [22%] conditional, four [2%] abnormal); 45 initiated hydroxyurea at a mean dose of 20·2 mg/kg per day (SD 1·4) with escalation to a mean dose of 27·4 mg/kg per day (5·1) after 12 months. Treatment response was analysed after 12 months (± 1 month; median 11 months, IQR 11-12) and 24 months (±3 months; median 22 months, 22-22). Transcranial Doppler velocities decreased to a mean of 149 cm/s (SD 27) compared with 182 cm/s (12) at baseline, which was significantly lower than baseline (p<0·0001), with an average decline of 35 cm/s (SD 23) after 12 months of treatment in 42 participants with paired results available at baseline and 12 months. No clinical strokes occurred, and 35 (83%) of 42 participants reverted to normal transcranial Doppler velocities. Clinical adverse events were mild, and dose-limiting toxicities were uncommon. The most common grade 3 adverse events were malaria (12 [29%] episodes in 45 patients) and sepsis (13 [32%] episodes). There were three serious adverse events, none of which were treatment-related, and no treatment-related deaths occurred. INTERPRETATION Children with sickle cell anaemia in Tanzania have a high baseline stroke risk. Hydroxyurea at the maximum tolerated dose significantly lowers transcranial Doppler velocities and reduces primary stroke risk. Transcranial Doppler screening plus hydroxyurea at the maximum tolerated dose is an effective stroke prevention strategy, supporting wider hydroxyurea access for patients with sickle cell anaemia across sub-Saharan Africa. FUNDING American Society of Hematology, National Institutes of Health, Cincinnati Children's Research Foundation.
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Affiliation(s)
- Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Teresa S Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Primrose Songoro
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Mwesige Charles
- Department of Laboratory Science, Bugando Medical Centre, Mwanza, Tanzania
| | - Adam C Lane
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan E Stuber
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abel N Makubi
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Luke R Smart
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
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9
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Abdullahi SU, Sunusi S, Abba MS, Sani S, Inuwa HA, Gambo S, Gambo A, Musa B, Covert Greene BV, Kassim AA, Rodeghier M, Hussaini N, Ciobanu M, Aliyu MH, Jordan LC, DeBaun MR. Hydroxyurea for secondary stroke prevention in children with sickle cell anemia in Nigeria: a randomized controlled trial. Blood 2023; 141:825-834. [PMID: 36322937 PMCID: PMC10023719 DOI: 10.1182/blood.2022016620] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
We tested the hypothesis that fixed oral moderate-dose hydroxyurea (20 mg/kg per day) for initial treatment of secondary stroke prevention results in an 80% relative risk reduction of stroke or death when compared with fixed oral low-dose hydroxyurea (10 mg/kg per day) in a phase 3 double-blind, parallel-group, randomized controlled trial in children with sickle cell anemia (SCA) living in Nigeria. A total of 101 participants were randomly allocated to low-dose (n = 49) and moderate-dose (n = 52) hydroxyurea treatment groups. The median participant follow-up was 1.6 years (interquartile range, 1.0-2.3), with a planned minimum follow-up of 3.0 years. A total of 6 recurrent strokes and 2 deaths vs 5 recurrent strokes and 3 deaths occurred in the low- and moderate-dose groups, respectively. The incidence rate ratio (IRR) of the primary outcome measure of stroke or death in the low- and moderate-dose hydroxyurea treatment groups was 0.98 (95% confidence interval [CI], 0.32-3.00; P = .97). The trial was stopped early owing to no clinical difference in the incidence rates of the primary outcome measure. The incidence rates of recurrent strokes were 7.1 and 6.0 per 100 person-years in the low- and moderate-dose groups, respectively, (IRR, 1.18; 95% CI, 0.30-4.88; P = .74). As a measure of adherence to the oral hydroxyurea therapy, the median percent of returned pills was 3.0% and 2.6% in the low- and moderate-dose groups, respectively. No participant had hydroxyurea therapy stopped for myelosuppression. For children with SCA in low-income settings without access to regular blood transfusion therapy, initial low-dose hydroxyurea is a minimum known efficacious dose for secondary stroke prevention.
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Affiliation(s)
- Shehu U. Abdullahi
- Department of Pediatrics, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Surayya Sunusi
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Saifuddeen Sani
- Department of Administration, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hauwau Aminu Inuwa
- Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Awwal Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Bilya Musa
- Department of Administration, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Brittany V. Covert Greene
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Adetola A. Kassim
- Department of Hematology and Oncology, Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN
| | | | - Nafiu Hussaini
- Department of Mathematical Sciences, Bayero University, Kano, Nigeria
| | - Mariana Ciobanu
- Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
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10
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Ambrose EE, Kidenya BR, Charles M, Ndunguru J, Jonathan A, Makani J, Minja IK, Ruggajo P, Balandya E. Outcomes of Hydroxyurea Accessed via Various Means and Barriers Affecting Its Usage Among Children with Sickle Cell Anaemia in North-Western Tanzania. J Blood Med 2023; 14:37-47. [PMID: 36712580 PMCID: PMC9875573 DOI: 10.2147/jbm.s380901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose To assess clinical and haematological outcomes of Hydroxyurea accessed via various access means and uncover the barriers to its utilization in children with Sickle cell anaemia (SCA), North-western Tanzania. Patients and Methods A retrospective study was conducted between October 2020 and April 2021 at Bugando Medical Centre (BMC) through review of medical files to compare the clinical and haematological outcomes among children with SCA at baseline and followed up retrospectively for at least one year of hydroxyurea utilization, accessed via cash, insurance and projects. Subsequently, a cross-sectional survey was conducted among parents and caregivers to ascertain the barriers to access of hydroxyurea via the various means. The p-values <0.05 were considered statistically significant. Results We identified 87 children with SCA who were on hydroxyurea for at least one year. The median age at baseline (before hydroxyurea) was 99 [78-151] months, and 52/87 (59.8%) were male. Compared to baseline, there was a significant reduction in proportion of patients reporting vaso-occlusive crisis, admissions and blood transfusions, a significant increase in Haemoglobin and mean corpuscular volume, conversely a significant reduction in absolute neutrophil and reticulocytes to both insurance and project participants. There was no significant change in most of these parameters among patients who accessed hydroxyurea via cash. Further, a total of 24/87 (27.6%) participants reported different barriers to access of hydroxyurea, where 10/24 (41.7%) reported hydroxyurea to be very expensive, 10/24 (41.7%) reported insurance challenges, and 4/21 (16.6%) reported unavailability of the drug. Conclusion The paediatric patients utilizing hydroxyurea accessed via insurance and projects, but not cash, experienced significant improvement in the clinical and haematological outcomes. Several barriers for access to hydroxyurea were observed which appeared to impact these outcomes. These findings call for concerted efforts to improve the sustainable access to hydroxyurea among all patients with SCA.
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Affiliation(s)
- Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania,Correspondence: Emmanuela E Ambrose, Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania, Tel +255789733833, Fax +255282500799, Email
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mwesige Charles
- Department of Laboratory Services, Bugando Medical Centre, Mwanza, Tanzania
| | - Joyce Ndunguru
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agnes Jonathan
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Irene K Minja
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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11
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Muacevic A, Adler JR, Yashi K, Gopalakrishnan Ravikumar NP, Parmar N, Dankhara N, Satodiya V. Pediatric Sickle Cell Disease and Stroke: A Literature Review. Cureus 2023; 15:e34003. [PMID: 36811060 PMCID: PMC9939049 DOI: 10.7759/cureus.34003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Both ischemic and hemorrhagic strokes in children can be a complication of sickle cell disease, which also affects adults. The occurrence is high without any screening or preventative care. This review article found that although transcranial Doppler (TCD) has reduced the prevalence of stroke in pediatric patients, there is still a need for an epidemiological survey to define such screening for adults, the ideal dose of hydroxyurea to reduce the incidence of stroke, and to identify silent cerebral stroke to prevent its complications. Increased hydroxyurea prescription and specific antibiotic and vaccination regimes lowered the occurrence of this condition. In pediatric cases with a time-averaged mean of the maximal velocity greater than 200cm/s, transcranial Doppler screening and preventive chronic transfusion for at least the first year have lowered the occurrence of stroke by up to 10 times. The ideal dose of hydroxyurea is still debatable, but it seems to reduce the risk of the first stroke to a comparable level in the average population. Adult ischemic and hemorrhagic stroke prevention has not yet received the same attention. Though there are fewer studies, sickle cell disease is also more common than age-matched controls in terms of silent cerebral infarction on magnetic resonance imaging (MRI), as well as other neurological problems such as cognitive impairment, seizures, and headaches. Currently, there is no evidence-supported way to prevent ischemic stroke in adults at any age. Also, there is no defined ideal dose of hydroxyurea that can be helpful in preventing strokes. Data also lack a way to identify a silent cerebral infarction, so its complications can be prevented. An additional epidemiological survey may help in the prevention of the condition. The primary aim of this article was to emphasize the importance of information on clinical, neuropsychological, and quantitative MRI assessment of sickle cell patients to understand the epidemiology and etiology of stroke in sickle cell patients to prevent stroke and its related morbidity.
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12
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Muacevic A, Adler JR, AlSubaie RN, Alzahrani LD, Albalawi IAJ, Alali YA, Yousuf MM, Alharbi HM, Alamri NS, Jamil SF. Blood Transfusion Vs. Hydroxyurea for Stroke Prevention in Children With Sickle Cell Anemia: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e31778. [PMID: 36569706 PMCID: PMC9774052 DOI: 10.7759/cureus.31778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Sickle cell anemia (SCA) is a hereditary condition that can lead to severe complications in children such as acute coronary syndrome, splenic sequestration, renal failure, and stroke. Blood transfusion and hydroxyurea (HU) therapy are used to prevent stroke in children with sickle cell disease (SCD). Preliminary data show considerable variation and inconsistency in the use of these two therapeutic interventions. Therefore, this systematic review was carried out to compare the effects of blood transfusion to HU therapy in preventing stroke for children with sickle cell disease. There was an extensive literature search in reliable and authentic databases like PubMed, Medline, Scopus, Cochrane, and Science Direct to obtain relevant articles. This study used the standards and guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During the systematic review, data were obtained focusing on the following parameters: the size of the sample in the study, the age of the subjects involved in the study, the type of Intervention, and the outcome. After an initial search of 163 papers, 25 studies were included. The results of the research give the first evidence that HU is effective in the treatment of cerebrovascular problems in children with SCD. However, it is unclear under what circumstances HU may prevent a second stroke. It can be concluded that children with SCA can effectively avoid primary strokes through chronic blood transfusions and HU.
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13
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Bernaudin F, Arnaud C, Kamdem A, Hau I, Madhi F, Jung C, Epaud R, Verlhac S. Incidence, kinetics, and risk factors for intra- and extracranial cerebral arteriopathies in a newborn sickle cell disease cohort early assessed by transcranial and cervical color Doppler ultrasound. Front Neurol 2022; 13:846596. [PMID: 36188389 PMCID: PMC9515365 DOI: 10.3389/fneur.2022.846596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
The risk of stroke in children with sickle cell disease (SCD) is detected by abnormal intracranial arterial time-averaged mean of maximum velocities (TAMVs ≥200 cm/s). Recently, extracranial internal carotid artery (eICA) arteriopathy has been reported, and a cross-sectional study showed that eICA-TAMVs ≥160 cm/s are significantly associated with eICA kinkings and stenosis. The cumulative incidence of and predictive risk factors for intracranial arteriopathy are well described in sickle cell anemia (SCA=SS/Sβ0) but are lacking for SC/Sβ+ children, as is the cumulative incidence of eICA arteriopathy. We report a prospective longitudinal cohort study including 493 children with SCD (398 SCA, 95 SC/Sβ+), all assessed by transcranial and cervical color Doppler ultrasound. Cerebral MRI/MRA data were available in 375 children with SCD and neck MRA in 365 children. eICA kinkings were defined as eICA tortuosities on neck MRA, with an internal acute angle between the two adjacent segments <90°. The median follow-up was 10.6 years. The cumulative incidence of kinkings was significantly lower in SC/Sβ+ children than in children with SCA, and no SC/Sβ+ child developed intra- or extracranial stenotic arteriopathy. The 10-year KM estimate of cumulative incidence (95% CI) for eICA-TAMVs ≥160 cm/s revealed its development in the 2nd year of life in children with SCA, reaching a plateau of 17.4% (13.2–21.6%) by about 10 years of age, while the plateau for eICA stenosis was 12.3% (8.3–16.3%). eICA assessment identified 13.5% (9.3–17.7%) patients at risk of stroke who were not detected by transcranial color Doppler ultrasound. We also show, for the first time, that in addition to a congenital origin, eICA kinkings sin patients with SCD can develop progressively with aging as a function of eICA-TAMVs, themselves related to anemia severity. Ongoing hydroxyurea treatment was significantly associated with a lower risk of abnormal intracranial arteriopathy and eICA kinkings. After adjustment with hydroxyurea, baseline low hemoglobin, high reticulocyte, and WBC counts remained independent risk factors for intracranial arteriopathy, while low hemoglobin and SEN β-haplotype number were independent risk factors for extracranial arteriopathy. The association between extracranial arteriopathy and SEN β-haplotype number suggested a genetic link between the ethnic origin and incidence of eICA kinkings. This prospective cohort study shows the importance of systematically assessing the eICA and of recording biological parameters during the 2nd year of life before any intensive therapy to predict the risk of cerebral arteriopathy and treat patients with severe baseline anemia.
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Affiliation(s)
- Françoise Bernaudin
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
- Clinical Research Center, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
- *Correspondence: Françoise Bernaudin
| | - Cécile Arnaud
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Annie Kamdem
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Isabelle Hau
- Department of Pediatrics, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Fouad Madhi
- Department of Pediatrics, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Camille Jung
- Clinical Research Center, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Ralph Epaud
- Department of Pediatrics, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Suzanne Verlhac
- Department of Medical Imaging, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, Créteil, France
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14
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Smart LR, Ambrose EE, Balyorugulu G, Songoro P, Shabani I, Komba P, Charles M, Howard TA, McElhinney KE, O'Hara SM, Odame J, Nakafeero M, Adams J, Stuber SE, Lane A, Latham TS, Makubi AN, Ware RE. Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa. Acta Haematol 2022; 146:95-105. [PMID: 35977532 PMCID: PMC10100573 DOI: 10.1159/000526322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Stroke is a severe complication of sickle cell anemia (SCA), with devastating sequelae. Transcranial Doppler (TCD) ultrasonography predicts stroke risk, but implementing TCD screening with suitable treatment for primary stroke prevention in low-resource environments remains challenging. SPHERE (NCT03948867) is a prospective phase 2 open-label hydroxyurea trial for SCA in Tanzania. METHODS After formal training and certification, local personnel screened children 2-16 years old; those with conditional (170-199 cm/s) or abnormal (≥200 cm/s) time-averaged mean velocities (TAMVs) received hydroxyurea at 20 mg/kg/day with dose escalation to maximum tolerated dose (MTD). The primary study endpoint is change in TAMV after 12 months of hydroxyurea; secondary endpoints include SCA-related clinical events, splenic volume and function, renal function, infections, hydroxyurea pharmacokinetics, and genetic modifiers. RESULTS Between April 2019 and April 2020, 202 children (average 6.8 ± 3.5 years, 53% female) enrolled and underwent TCD screening; 196 were deemed eligible by DNA testing. Most had numerous previous hospitalizations and transfusions, with low baseline hemoglobin (7.7 ± 1.1 g/dL) and %HbF (9.3 ± 5.4%). Palpable splenomegaly was present at enrollment in 49 (25%); average sonographic splenic volume was 103 mL (range 8-1,045 mL). TCD screening identified 22% conditional and 2% abnormal velocities, with hydroxyurea treatment initiated in 96% (45/47) eligible children. CONCLUSION SPHERE has built local capacity with high-quality research infrastructure and TCD screening for SCA in Tanzania. Fully enrolled participants have a high prevalence of elevated baseline TCD velocities and splenomegaly. SPHERE will prospectively determine the benefits of hydroxyurea at MTD for primary stroke prevention, anticipating expanded access to hydroxyurea treatment across Tanzania.
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Affiliation(s)
- Luke R. Smart
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emmanuela E. Ambrose
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Idd Shabani
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Thad A. Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathryn E. McElhinney
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara M. O'Hara
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jodie Odame
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Maria Nakafeero
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Janet Adams
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan E. Stuber
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam Lane
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Teresa S. Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Abel N. Makubi
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | - Russell E. Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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15
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Dua M, Bello-Manga H, Carroll YM, Galadanci AA, Ibrahim UA, King AA, Olanrewaju A, Estepp JH. Strategies to increase access to basic sickle cell disease care in low- and middle-income countries. Expert Rev Hematol 2022; 15:333-344. [PMID: 35400264 PMCID: PMC9442799 DOI: 10.1080/17474086.2022.2063116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/04/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Over 90% of those born with SCD live in low- and middle-income countries (LMICs), yet individuals in these settings have much poorer outcomes compared to those in high-income countries. AREAS COVERED This manuscript provides an in-depth review of the cornerstones of basic SCD care, the barriers to implementing these in LMICs, and strategies to increase access in these regions. Publications in English language, peer-reviewed, and edited from 2000 to 2021 were identified on PubMed. Google search was used for gray literature. EXPERT OPINION Outcomes for patients with SCD in high-income countries have improved over the last few decades due to the implementation of universal newborn screening programs and use of routine antimicrobial prophylaxis, increase in therapeutic and curative options, and the adoption of specific measures to decrease risk of stroke. This success has not translated to LMICs due to several reasons including resource constraints. A combination of several strategies is needed to increase access to basic SCD care for patients in these settings.
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Affiliation(s)
- Meghna Dua
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Halima Bello-Manga
- Department of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Nigeria
| | - Yvonne M. Carroll
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | | | - Allison A. King
- in Occupational Therapy, Departments of Pediatrics, Medicine and Surgery, Washington University School of MedicineProgram , St. Louis, USA
| | - Ayobami Olanrewaju
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jeremie H. Estepp
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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16
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Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
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17
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Ghafuri DL, Abdullahi SU, Dambatta AH, Galadanci J, Tabari MA, Bello-Manga H, Idris N, Inuwa H, Tijjani A, Suleiman AA, Jibir BW, Gambo S, Gambo AI, Khalifa Y, Haliru L, Abdulrasheed S, Zakari MA, Greene BC, Trevathan E, Jordan LC, Aliyu MH, Baumann AA, DeBaun MR. Establishing Sickle Cell Disease Stroke Prevention Teams in Africa is Feasible: Program Evaluation Using the RE-AIM Framework. J Pediatr Hematol Oncol 2022; 44:e56-e61. [PMID: 34001783 PMCID: PMC8728755 DOI: 10.1097/mph.0000000000002179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team's readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program's 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program's feasibility and short-term sustainability.
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Affiliation(s)
- Djamila L. Ghafuri
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
| | | | | | | | | | | | | | | | | | | | | | - Safiya Gambo
- Pediatrics, Murtala Mohammed Specialist Hospital
| | | | - Yusuf Khalifa
- Department of Administration, Aminu Kano Teaching Hospital, Kano
| | - Lawal Haliru
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Sani Abdulrasheed
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | | | - Brittany C. Greene
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
| | - Edwin Trevathan
- Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology
| | - Muktar H. Aliyu
- Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center
| | - Ana A. Baumann
- Brown School of Social Work, Washington University of St. Louis, St. Louis, MO
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
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18
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Abdullahi SU, Jibir BW, Bello-Manga H, Gambo S, Inuwa H, Tijjani AG, Idris N, Galadanci A, Hikima MS, Galadanci N, Borodo A, Tabari AM, Haliru L, Suleiman A, Ibrahim J, Greene BC, Ghafuri DL, Rodeghier M, Slaughter JC, Kirkham FJ, Neville K, Kassim A, Trevathan E, Jordan LC, Aliyu MH, DeBaun MR. Hydroxyurea for primary stroke prevention in children with sickle cell anaemia in Nigeria (SPRING): a double-blind, multicentre, randomised, phase 3 trial. Lancet Haematol 2022; 9:e26-e37. [PMID: 34971579 PMCID: PMC10072240 DOI: 10.1016/s2352-3026(21)00368-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In high-income countries, standard care for primary stroke prevention in children with sickle cell anaemia and abnormal transcranial Doppler velocities results in a 92% relative risk reduction of strokes but mandates initial monthly blood transfusion. In Africa, where regular blood transfusion is not feasible for most children, we tested the hypothesis that initial moderate-dose compared with low-dose hydroxyurea decreases the incidence of strokes for children with abnormal transcranial Doppler velocities. METHODS SPRING is a double-blind, parallel-group, randomised, controlled, phase 3 trial of children aged 5-12 years with sickle cell anaemia with abnormal transcranial Doppler velocities conducted at three teaching hospitals in Nigeria. For randomisation, we used a permuted block allocation scheme with block sizes of four, stratified by sex and site. Allocation was concealed from all but the pharmacists and statisticians. Participants were assigned in a 1:1 ratio to low-dose (10 mg/kg per day) or moderate-dose (20 mg/kg per day) oral hydroxyurea taken once daily with monthly clinical evaluation and laboratory monitoring. The primary outcome was initial stroke or transient ischaemic attack, centrally adjudicated. The secondary outcome was all-cause hospitalisation. We used the intention-to-treat population for data analysis. The trial was stopped early for futility after a planned minimum follow-up of 3·0 years to follow-up for participants. This trial was registered with ClinicalTrials.gov, number NCT02560935. FINDINGS Between Aug 2, 2016, and June 14, 2018, 220 participants (median age 7·2 years [IQR 5·5-8·9]; 114 [52%] female) were randomly allocated and followed for a median of 2·4 years (IQR 2·0-2·8). All participants were Nigerian and were from the following ethnic groups: 179 (82%) people were Hausa, 25 (11%) were Fulani, and 16 (7%) identified as another ethnicity. In the low-dose hydroxyurea group, three (3%) of 109 participants had strokes, with an incidence rate of 1·19 per 100 person-years and in the moderate-dose hydroxyurea group five (5%) of 111 had strokes with an incidence rate of 1·92 per 100 person-years (incidence rate ratio 0·62 [95% CI 0·10-3·20], p=0·77). The incidence rate ratio of hospitalisation for any reason was 1·71 (95% CI 1·15-2·57, p=0·0071), with higher incidence rates per 100 person-years in the low-dose group versus the moderate-dose group (27·43 vs 16·08). No participant had hydroxyurea treatment stopped for myelosuppression. INTERPRETATION Compared with low-dose hydroxyurea therapy, participants treated with moderate-dose hydroxyurea had no difference in the stroke incidence rate. However, secondary analyses suggest that the moderate-dose group could lower incidence rates for all-cause hospitalisations. These findings provide an evidence-based guideline for the use of low-dose hydroxyurea therapy for children with sickle cell anaemia at risk of stroke. FUNDING National Institute of Neurological Disorders and Stroke.
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Affiliation(s)
- Shehu U Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Binta W Jibir
- Department of Pediatrics, Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | - Halima Bello-Manga
- Department of Haematology and Blood Transfusion, Kaduna State University/Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Hauwa Inuwa
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aliyu G Tijjani
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Nura Idris
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Aisha Galadanci
- Department of Haematology and Blood Transfusion, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mustapha S Hikima
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Najibah Galadanci
- Department of Epidemiology, School of Public health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Awwal Borodo
- Department of Medicine, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Abdulkadir M Tabari
- Department of Radiology, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Lawal Haliru
- Department of Pediatrics, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Aisha Suleiman
- Department of Pediatrics, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Jamila Ibrahim
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Brittany C Greene
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Djamila L Ghafuri
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James C Slaughter
- Department of Biostatistics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fenella J Kirkham
- Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Kathleen Neville
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adetola Kassim
- Department of Hematology and Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edwin Trevathan
- Vanderbilt Institute for Global Health, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Neurology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C Jordan
- Department of Pediatrics, Neurology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
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19
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Han H, Hensch L, Tubman VN. Indications for transfusion in the management of sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:696-703. [PMID: 34889416 PMCID: PMC8791131 DOI: 10.1182/hematology.2021000307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The transfusion of red blood cells (RBCs) is a crucial treatment for sickle cell disease (SCD). While often beneficial, the frequent use of transfusions is associated with numerous complications. Transfusions should be offered with specific guidelines in mind. Here we present updates to the indications for transfusion of RBCs in SCD. We review recent publications and include expert perspectives from hematology and transfusion medicine. For some clinical indications, such as ischemic stroke, the role of transfusion has been well studied and can be applied almost universally. For many other clinical scenarios, the use of transfusion therapy has less conclusive data and therefore must be tailored to individual needs. We highlight the roles of RBC transfusions in preventing or mitigating neurological disease, in reducing perioperative complications, in managing acute chest syndrome, and in optimizing pregnancy outcomes in SCD. We further highlight various transfusion techniques and when each might be considered. Potential complications of transfusion are also briefly discussed.
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Affiliation(s)
- Hyojeong Han
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Lisa Hensch
- Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, TX
- Department of Pathology and Immunology and Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Venée N Tubman
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
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20
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Ghafuri DL, Greene BC, Musa B, Gambo A, Sani A, Abdullahi S, Widil BJ, Bello-Manga H, Gambo S, Ghafuri M, Cassell H, Neville K, Kirkham F, Kassim AA, Aliyu MH, DeBaun MR, Jordan LC. Capacity Building for Primary Stroke Prevention Teams in Children Living With Sickle Cell Anemia in Africa. Pediatr Neurol 2021; 125:9-15. [PMID: 34563875 PMCID: PMC8559257 DOI: 10.1016/j.pediatrneurol.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nigeria has the highest proportion of children with sickle cell anemia (SCA) globally; an estimated 150,000 infants with SCA are born annually. Primary stroke prevention in children with SCA must include Nigeria. We describe capacity-building strategies in conjunction with two National Institutes of Health-funded primary stroke prevention trials (a feasibility trial and phase III randomized controlled trial) with initial hydroxyurea treatment for children with SCA and abnormal transcranial Doppler (TCD) velocities in Nigeria. We anticipated challenges to conducting clinical trials in a low-resource setting with a local team that had not previously been involved in clinical research and sought a sustainable strategy for primary stroke prevention. METHODS This is a descriptive, prospective study of challenges, solutions, and research teams in two trials that enrolled a total of 679 children with SCA. RESULTS As part of the capacity-building component of the trials, over eight years, 23 research personnel (physicians, nurses, research coordinators, a statistician, and a pharmacist) completed a one-month research governance and ethics training program at Vanderbilt University Medical Center, USA. A lead research coordinator for each site completed the Society of Clinical Research Professionals certification. TCD machines were donated; radiologists and nonradiologists were trained and certified to perform TCD. A scalable E-prescription was implemented to track hydroxyurea treatment. We worked with regional government officials to support ongoing TCD-based screening and funding for hydroxyurea for children with SCA at a high risk of stroke. CONCLUSIONS Our trials and capacity building demonstrate a sustainable strategy to initiate and maintain pediatric SCA primary stroke prevention programs in Africa.
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Affiliation(s)
- Djamila L. Ghafuri
- Vanderbilt-Meharry Sickle Cell Center for Excellence, Department of Pediatrics, Vanderbilt University School of Medicine, Tennessee, U.S.A
| | - Brittany Covert Greene
- Vanderbilt-Meharry Sickle Cell Center for Excellence, Department of Pediatrics, Vanderbilt University School of Medicine, Tennessee, U.S.A
| | - Bilya Musa
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Awwal Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Abdulrasheed Sani
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Shehu Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Binta J. Widil
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Halima Bello-Manga
- Department of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Matin Ghafuri
- Vanderbilt-Meharry Sickle Cell Center for Excellence, Department of Pediatrics, Vanderbilt University School of Medicine, Tennessee, U.S.A
| | - Holly Cassell
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, U.S.A
| | - Kathleen Neville
- Department of Pediatrics, Divisions of Pediatric Hematology-Oncology and Clinical Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Fenella Kirkham
- Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children’s Hospital, Little Rock, AR, U.S.A
| | - Adetola A. Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, U.S.A
| | - Muktar H. Aliyu
- Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Tennessee, U.S.A
| | - Michael R. DeBaun
- Vanderbilt-Meharry Sickle Cell Center for Excellence, Department of Pediatrics, Vanderbilt University School of Medicine, Tennessee, U.S.A
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University of Medicine, Tennessee, U.S.A
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21
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Karkoska K, McGann PT. How I approach disease-modifying therapy in children with sickle cell disease in an era of novel therapies. Pediatr Blood Cancer 2021; 68:e29363. [PMID: 34550643 DOI: 10.1002/pbc.29363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022]
Abstract
Finally,after decades of stagnation, the therapeutic landscape for sickle cell disease (SCD) is changing with an increasing number of novel therapeutics. Hydroxyurea remains the primary disease-modifying therapy and, when started early in life with maintenance of an optimal dose, can reduce many SCD-related complications. To complement hydroxyurea, there are a growing number of pharmacologic options with additional efforts focused on the development and optimization of curative therapies. Here, we review current treatment options and provide recommendations as to how to approach the treatment of children and adolescents within this evolving therapeutic landscape to allow for full and healthy lives.
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Affiliation(s)
- Kristine Karkoska
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patrick T McGann
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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22
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Loggetto SR, Veríssimo MPDA, Darrigo-Junior LG, Simões RDS, Bernardo WM, Braga JAP. Guidelines on sickle cell disease: primary stroke prevention in children and adolescents. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Guidelines project: Associação Médica Brasileira - 2021. Hematol Transfus Cell Ther 2021; 44:85-94. [PMID: 34857507 PMCID: PMC8885378 DOI: 10.1016/j.htct.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sandra Regina Loggetto
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Grupo Gestor de Serviços de Hematologia (GSH), São Paulo, SP, Brazil; Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil.
| | - Mônica Pinheiro de Almeida Veríssimo
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Centro Infantil de Investigações Hematológicas Dr. Domingos A. Boldrini, Campinas, SP, Brazil
| | - Luiz Guilherme Darrigo-Junior
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), Ribeirão Preto, SP, Brazil
| | - Ricardo Dos Santos Simões
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil; Associação Médica Brasileira (AMB), São Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Associação Médica Brasileira (AMB), São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | - Josefina Aparecida Pellegrini Braga
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM UNIFESP), São Paulo, SP, Brazil
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23
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Kirkham FJ, Lagunju IA. Epidemiology of Stroke in Sickle Cell Disease. J Clin Med 2021; 10:4232. [PMID: 34575342 PMCID: PMC8469588 DOI: 10.3390/jcm10184232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is the most common cause of stroke in childhood, both ischaemic and haemorrhagic, and it also affects adults with the condition. Without any screening or preventative treatment, the incidence appears to fall within the range 0.5 to 0.9 per 100 patient years of observation. Newborn screening with Penicillin prophylaxis and vaccination leading to reduced bacterial infection may have reduced the incidence, alongside increasing hydroxyurea prescription. Transcranial Doppler screening and prophylactic chronic transfusion for at least an initial year has reduced the incidence of stroke by up to 10-fold in children with time averaged mean of the maximum velocity >200 cm/s. Hydroxyurea also appears to reduce the incidence of first stroke to a similar extent in the same group but the optimal dose remains controversial. The prevention of haemorrhagic stroke at all ages and ischaemic stroke in adults has not yet received the same degree of attention. Although there are fewer studies, silent cerebral infarction on magnetic resonance imaging (MRI), and other neurological conditions, including headache, epilepsy and cognitive dysfunction, are also more prevalent in sickle cell disease compared with age matched controls. Clinical, neuropsychological and quantitative MRI screening may prove useful for understanding epidemiology and aetiology.
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Affiliation(s)
- Fenella Jane Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, 30 Guilford Street, London WC1N 1EH, UK
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton SO16 6YD, UK
- Paediatric Neurosciences, King’s College Hospital, London SE5 9RS, UK
| | - Ikeoluwa A. Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan PMB 3017, Nigeria;
- Department of Paediatrics, University College Hospital, Ibadan PMB 5116, Nigeria
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24
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Pecker LH, Sharma D, Nero A, Paidas MJ, Ware RE, James AH, Smith-Whitley K. Knowledge gaps in reproductive and sexual health in girls and women with sickle cell disease. Br J Haematol 2021; 194:970-979. [PMID: 34231198 PMCID: PMC8448913 DOI: 10.1111/bjh.17658] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 02/02/2023]
Abstract
There is an immediate need to address long-standing questions about the reproductive health of girls and women with sickle cell disease (SCD). There are many SCD-related reproductive risks and uncertainties across girls' and women's reproductive life span, with particularly outstanding concerns about menstruation, contraception, fertility and pregnancy. Extant literature addressing women's reproductive health topics is mostly descriptive; there are few high-quality interventional studies. In 2020, the Centers for Disease Control and Prevention and the Foundation for Women and Girls with Blood Disorders convened an expert panel to assess the knowledge gaps in women's reproductive health in SCD. The panel identified significant limitations to clinical care due to the need for research. The panel also identified prominent barriers to research and care. In this report, we frame these issues, providing a roadmap for investigators, funding agencies, and policy makers to advance care for girls and women with SCD.
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Affiliation(s)
- Lydia H. Pecker
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine & Gynecology & Obstetrics, Baltimore MD
| | - Deva Sharma
- Vanderbilt University Medical Center, Divisions of Transfusion Medicine and Hematology
| | - Alecia Nero
- Department of Medicine, Division of Hematology/Oncology, University of Texas Southwestern
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine
| | - Russell E. Ware
- Division of Pediatric Hematology, Department of Pediatrics, Cincinnati Children’s Hospital
| | - Andra H. James
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Department of Medicine, Division of Hematology, Duke University, Durham, NC
| | - Kim Smith-Whitley
- Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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25
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Idris IM, Yusuf AA, Gwarzo DH, Kurawa MS, Shuaib A, Galadanci AA, Ibrahim H, Borodo AM, Jobbi YD, Danagundi MB, Borodo SB, Mohammed IY, Galadanci NA, Kuliya-Gwarzo A. High Systolic Blood Pressure, Anterior Segment Changes and Visual Impairment Independently Predict Sickle Cell Retinopathy. Hemoglobin 2021; 45:228-233. [PMID: 34353203 DOI: 10.1080/03630269.2021.1957927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sickle cell disease is often complicated by retinopathy, which can be proliferative or non proliferative. Proliferative sickle cell retinopathy potentially leads to blindness. There is a paucity of data on sickle cell disease-related retinopathy from Africa, where the disease is most prevalent. We aimed to determine the clinical, ophthalmic, and laboratory predictors of sickle cell retinopathy in an African population. We conducted a cross-sectional study of 262 participants, aged 13 years and above, with sickle cell disease. Demographic and clinical data were collected using a structured questionnaire and standard physical examinations. Vitreo-retinal specialists performed eye examinations on all the participants. Hematological and biochemical assessments were conducted using standard methods. A multivariate stepwise forward logistic regression was performed to determine the predictors of retinopathy. The median age of the participants was 20 years (interquartile range: 17-25 years). Most of the participants had a homozygous Hb S (HBB: c.20A>T) genotype (96.9%), with 3.1% who carried a Hb S/Hb C (HBB: c.19G>A) genotype. The prevalence of non proliferative sickle cell retinopathy was 24.4%. Only 1.9% had proliferative sickle cell retinopathy (PSCR). Elevated systolic blood pressure (BP) [odds ratio (OR): 6.85, 95% confidence interval (95% CI): 1.05-44.45, p = 0.059], moderate visual impairment (OR: 5.2, 95% CI: 1.39-19.63, p = 0.015), and anterior segment changes (OR: 2.21, 95% CI: 1.19-4.13, p = 0.012) were independently predictive of retinopathy. This study provides new insight into predictors of retinopathy in sickle cell disease, with implications on early screening and prevention.
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Affiliation(s)
- Ibrahim M Idris
- Department of Hematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aminu A Yusuf
- Department of Hematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria.,College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Dalha H Gwarzo
- Department of Hematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria.,College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Musbahu S Kurawa
- College of Health Sciences, Bayero University Kano, Kano, Nigeria.,Department of Ophthalmology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdulsalam Shuaib
- College of Health Sciences, Bayero University Kano, Kano, Nigeria.,Department of Ophthalmology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aisha A Galadanci
- Department of Hematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria.,College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Hauwa Ibrahim
- Department of Hematology, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Awwal M Borodo
- Department of Hematology, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Yusuf D Jobbi
- Department of Hematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Maryam B Danagundi
- Department of Ophthalmology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sakinatu B Borodo
- Department of Ophthalmology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Idris Y Mohammed
- College of Health Sciences, Bayero University Kano, Kano, Nigeria.,Department of Chemical Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Najibah A Galadanci
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Aisha Kuliya-Gwarzo
- Department of Hematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria.,College of Health Sciences, Bayero University Kano, Kano, Nigeria
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26
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Rankine-Mullings A, Reid M, Soares D, Taylor-Bryan C, Wisdom-Phipps M, Aldred K, Latham T, Schultz WH, Knight-Madden J, Badaloo A, Lane A, Adams RJ, Ware RE. Hydroxycarbamide treatment reduces transcranial Doppler velocity in the absence of transfusion support in children with sickle cell anaemia, elevated transcranial Doppler velocity, and cerebral vasculopathy: the EXTEND trial. Br J Haematol 2021; 195:612-620. [PMID: 34291449 DOI: 10.1111/bjh.17698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
EXpanding Treatment for Existing Neurological Disease (EXTEND) investigated whether hydroxycarbamide lowers transcranial Doppler (TCD) velocities in Jamaican children with sickle cell anaemia (SCA) and elevated TCD velocity with or without previous stroke. Forty-three children (age 2-17 years) with baseline maximum time-averaged mean velocity (TAMV) ≥ 170 cm/s were stratified into three risk categories based on treatment status and stroke history: Group 1 (no history of stroke, on hydroxycarbamide, n = 12); and Groups 2 (no stroke, no hydroxycarbamide, n = 21) and 3 (previous stroke, no hydroxycarbamide, n = 10). Open-label hydroxycarbamide at 20 mg/kg/day was commenced, with escalation to maximum tolerated dose (MTD) based on mild marrow suppression (average dose 25·4 ± 4·5 mg/kg/day). TCD was performed every six months with brain magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) at baseline and after 18-months of hydroxycarbamide. The maximum TAMV decreased significantly compared to baseline (24 ± 30 cm/s, P < 0·0001), with similar declines in all groups. Clinical stroke occurred in five children, one in Group 1, none in Group 2, and four in Group 3, P = 0·0032, comparing group incidence rates. Brain MRI/MRA was stable in children without clinical stroke. EXTEND documents the feasibility and benefits of hydroxycarbamide at MTD to lower TCD velocities and reduce stroke risk in children with SCA and no history of primary stroke in low-resource settings without transfusion management.
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Affiliation(s)
- Angela Rankine-Mullings
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Marvin Reid
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Kingston, Jamaica
| | - Deanne Soares
- Radiology Section, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston, Jamaica
| | - Carolyn Taylor-Bryan
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Kingston, Jamaica
| | - Margaret Wisdom-Phipps
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Karen Aldred
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Teresa Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William H Schultz
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Asha Badaloo
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research Institute, The University of the West Indies, Kingston, Jamaica
| | - Adam Lane
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert J Adams
- Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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27
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Nnebe-Agumadu U, Adebayo I, Erigbuem I, James E, Kumode E, Nnodu O, Adekile A. Hydroxyurea in children with sickle cell disease in a resource-poor setting: Monitoring and effects of therapy. A practical perspective. Pediatr Blood Cancer 2021; 68:e28969. [PMID: 33788390 DOI: 10.1002/pbc.28969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although effectiveness of hydroxyurea (HU) in sickle cell disease is well established, unanswered questions persist about its use in African children. We determined real-life issues of acceptability, availability, and monitoring of HU use in Nigeria. METHODS A retrospective longitudinal review of laboratory data of patients on HU was done from case files, followed by a cross-sectional survey that captured families' perception of medication and clinic adherence, laboratory tests, benefits, side effects, and acceptability. RESULTS One hundred sixteen patients (1.2-17 years) received HU (mean ± SD = 18.5 ± 4.3 mg/kg/day) in 33 months. Eighty-nine had laboratory analysis. Dose escalation was the initial goal, but only 80% of patients had some form of it. Parents reported improvement in general well-being and reduction in bone pain episodes, hospital admissions, and blood transfusion. While most parents (89.5%) reported satisfaction with HU, 61% reported dissatisfaction with daily drug use, and the frequency and cost of monitoring. Sixteen percent voluntarily stopped therapy. Adherence to daily HU was 88.8%, doctor's appointments 24.5%, hematology tests 18.9%, and organ function tests 37.4%. There were no significant toxicities. Significant increases in hemoglobin, hemoglobin F and mean corpuscular volume, and reduction in absolute neutrophil count occurred despite inconsistent dose escalation. CONCLUSION HU (10-15 mg/kg/day starting dose) is safe and seems effective and acceptable to parents. Parental commitment to therapy, pre-HU education (that continues during therapy), provision of affordable HU, and subsidized laboratory tests are important considerations for initiating therapy. Special HU clinics may facilitate dose escalation and reduce frequency of monitoring. Studies are needed on feasibility of maximum tolerable dose HU protocols in sub-Saharan Africa without compromising safety.
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Affiliation(s)
- Uche Nnebe-Agumadu
- Department of Paediatrics, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Innocent Adebayo
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ifeanyi Erigbuem
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Esther James
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Evelyn Kumode
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Obiageli Nnodu
- Department of Hematology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Kuwait University, Kuwait City, Kuwait
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28
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Stroke and stroke prevention in sickle cell anemia in developed and selected developing countries. J Neurol Sci 2021; 427:117510. [PMID: 34077859 DOI: 10.1016/j.jns.2021.117510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
This comprehensive review provides an insight into the pathophysiology, epidemiology, evaluation, and treatment of sickle cell anemia (SCA)-related stroke in developed and developing countries. Vascular injury, hypercoagulability and vaso-occlusion play a role in the pathophysiology of stroke in SCA. Transcranial Doppler ultrasound (TCD) has lowered the incidence of ischemic stroke from 11% to 1% as TCD identifies children who are at risk for stroke, providing opportunities for interventions to reduce this risk. Whereas blood exchange is indicated in acute stroke, chronic transfusions (either simple or exchange on a monthly basis) are used for primary as well as secondary stroke prevention in developed countries. Children with abnormally high TCD velocities (≥ 200 cm/s) are at high risk of stroke and might benefit from hydroxyurea or hydroxycarbamide (HU) after a period of a successful transition from chronic transfusions. Hematopoietic stem cell transplant presents a cure for SCA. Gene therapy is currently investigated and may be offered to patients with SCA who had a stroke or who are at high risk of stroke if proven efficacious and safe. However, gene therapy is not likely to be implemented in low-income countries due to cost. Alternatively, HU is utilized for primary and secondary stroke prevention in developing countries. Further expansion of TCD implementation should be a priority in those settings.
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Lagunju IA, Labaeka A, Ibeh JN, Orimadegun AE, Brown BJ, Sodeinde OO. Transcranial Doppler screening in Nigerian children with sickle cell disease: A 10-year longitudinal study on the SPPIBA cohort. Pediatr Blood Cancer 2021; 68:e28906. [PMID: 33522690 DOI: 10.1002/pbc.28906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary stroke prevention programmes for children with sickle cell disease (SCD) have been shown to be feasible interventions in resource-poor countries. Different hydroxyurea (HU) regimens have been utilised in ameliorating the severity of SCD. OBJECTIVE To determine the long-term outcomes of the stroke prevention programme for children with SCD in Ibadan (SPPIBA), Nigeria. METHODS A longitudinal study of 396 children with haemoglobin SS disease who had been on the stroke prevention programme for a minimum period of 5 years. All enrollees had nonimaging TCD performed at baseline and thereafter 3-monthly or annually. Children with TCD velocities ≥170 cm/s were treated with HU by dose-escalation regimen. RESULTS The mean age at first TCD examination was 102 ± 46.7 months and the period of follow-up ranged from 5 to 10 years (mean = 7.2 ± 1.7). Time to significant decline in TCD velocities ranged from 5 to 35 months, (median = 10.0 months). The minimum dose of HU required to achieve significant decline in TCD velocities ranged from 15 to 31 mg/kg/day, mean 23.7 (±3.9). HU dose escalation beyond 20 mg/kg/day was required to attain significant reductions in the time-averaged mean of maximal velocities (TAMMV) in 69.1% of the cases. Two stroke events occurred giving a stroke incidence of 0.08 per 100 patient-years. CONCLUSION The majority of Nigerian children with SCD and elevated TCD velocities achieved significant decline in TAMMV within the first year of HU therapy but on higher doses of HU. It might be important to individualise HU doses for optimal outcomes in primary stroke prevention.
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Affiliation(s)
- IkeOluwa A Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Adeyemi Labaeka
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Joy N Ibeh
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Adebola E Orimadegun
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Biobele J Brown
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Olugbemiro O Sodeinde
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
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Aliyu MH, Sani MU, Ingles DJ, Tsiga-Ahmed FI, Musa BM, Audet CM, Wester CW. The V-BRCH Project: building clinical trial research capacity for HIV and noncommunicable diseases in Nigeria. Health Res Policy Syst 2021; 19:32. [PMID: 33691722 PMCID: PMC7943703 DOI: 10.1186/s12961-020-00656-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
Antiretroviral therapy has turned HIV into a chronic condition, with morbidity from HIV-associated noncommunicable diseases (NCDs) becoming more common as HIV-infected individuals live longer. In Nigeria, the additional challenge of an under-capacitated health system highlights the need for skilled clinical investigators who can generate evidence to tackle the double burden of HIV and NCDs. The Vanderbilt-Nigeria Building Research Capacity in HIV and Non-communicable Diseases (V-BRCH) programme is a training platform to create a cohort of skilled Nigerian investigators with the capacity to lead independent clinical trial research focused on the intersection of HIV and NCDs. V-BRCH will solidify an atmosphere of continuous mentoring and skills acquisition for physician faculty at the Aminu Kano Teaching Hospital via short- and medium-term learning opportunities, paired mentoring arrangements, and mentored research projects. Trainees will attend an annual faculty enrichment programme in Nashville, in addition to on-site workshops in Nigeria on HIV-associated NCD epidemiology, clinical trials methodology, evidence synthesis, qualitative research methods, stakeholder engagement, knowledge translation, and grant writing. Research-oriented junior faculty will undergo focused training in clinical trials administration and regulatory oversight. Scholars will share best practices through mentoring panels, regular ‘Works in Progress’ meetings, and monthly career development seminars. Competitive seed grants will be provided to mentor–mentee teams to promote targeted in-country pilot studies focused on HIV-associated NCDs. For long-term training, physician scientists will be supported to undergo enhanced Master of Public Health (MPH) training at Bayero University in Nigeria and Master of Science in Clinical Investigation (MSCI) training at Vanderbilt. Short-term regional courses, staff development workshops, and MPH curriculum refinement will help to strengthen institutional capacity in HIV-associated NCD clinical trial research. V-BRCH will create a cohort of skilled Nigerian scientists who will be able to compete for independent funding and design and implement high quality research that will generate evidence to inform policy and practice and lead to improved outcomes for Nigerians impacted by HIV-associated NCDs.
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Affiliation(s)
- Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 725, Nashville, TN, 37203, United States of America. .,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States of America. .,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.
| | - Mahmoud U Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 725, Nashville, TN, 37203, United States of America
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Baba M Musa
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria.,Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 725, Nashville, TN, 37203, United States of America.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - C William Wester
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 725, Nashville, TN, 37203, United States of America.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.,Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States of America
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31
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Gyamfi J, Ojo T, Epou S, Diawara A, Dike L, Adenikinju D, Enechukwu S, Vieira D, Nnodu O, Ogedegbe G, Peprah E. Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management: A systematic review of randomized controlled trials. PLoS One 2021; 16:e0246700. [PMID: 33596221 PMCID: PMC7888630 DOI: 10.1371/journal.pone.0246700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite ~90% of sickle cell disease (SCD) occurring in low-and middle-income countries (LMICs), the vast majority of people are not receiving evidence-based interventions (EBIs) to reduce SCD-related adverse outcomes and mortality, and data on implementation research outcomes (IROs) and SCD is limited. This study aims to synthesize available data on EBIs for SCD and assess IROs. METHODS We conducted a systematic review of RCTs reporting on EBIs for SCD management implemented in LMICs. We identified articles from PubMed/Medline, Global Health, PubMed Central, Embase, Web of Science medical subject heading (MeSH and Emtree) and keywords, published from inception through February 23, 2020, and conducted an updated search through December 24, 2020. We provide intervention characteristics for each study, EBI impact on SCD, and evidence of reporting on IROs. MAIN RESULTS 29 RCTs were analyzed. EBIs identified included disease modifying agents, supportive care agents/analgesics, anti-malarials, systemic treatments, patient/ provider education, and nutritional supplements. Studies using disease modifying agents, nutritional supplements, and anti-malarials reported improvements in pain crisis, hospitalization, children's growth and reduction in severity and prevalence of malaria. Two studies reported on the sustainability of supplementary arginine, citrulline, and daily chloroquine and hydroxyurea for SCD patients. Only 13 studies (44.8%) provided descriptions that captured at least three of the eight IROs. There was limited reporting of acceptability, feasibility, fidelity, cost and sustainability. CONCLUSION EBIs are effective for SCD management in LMICs; however, measurement of IROs is scarce. Future research should focus on penetration of EBIs to inform evidence-based practice and sustainability in the context of LMICs. CLINICAL TRIAL REGISTRATION This review is registered in PROSPERO #CRD42020167289.
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Affiliation(s)
- Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
| | - Sabrina Epou
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Amy Diawara
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Lotanna Dike
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Deborah Adenikinju
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Scholastica Enechukwu
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Dorice Vieira
- New York University Health Sciences Library, New York, New York, United States of America
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, New York University Medical Center, New York, New York, United States of America
| | - Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
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