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Namaganda P, Nantume P, Mubiru KR, Twimukye A, Wiltshire CS. Understanding patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, Uganda, a qualitative study. BMC Health Serv Res 2024; 24:666. [PMID: 38802815 PMCID: PMC11131175 DOI: 10.1186/s12913-024-11125-6] [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: 11/24/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In 2016, Uganda added Hydroxyurea (HU) to the list of essential drugs to treat sickle cell disease SCD. However, Hydroxyurea utilization has been low for several countries in sub-Saharan Africa. This study examined patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, in Uganda. METHODS To understand the patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease, we conducted a parallel convergent mixed methods study at outpatient departments of two national referral hospitals in Uganda from October 2022 to January 2023. The cross-sectional mixed-methods study employed both quantitative and qualitative methods. We collected survey data from a systematic sample of 259 participants and conducted individual interviews with a purposive sample of 40 participants (20 adolescents or their caregivers and 20 adult patients with SCD) and interviewed them individually on their knowledge, perceptions, barriers, and facilitators of HU utilization. Descriptive data were analyzed using Stata 16, whereas qualitative data were analyzed thematically using an inductive approach supported by NVivo 12 software. We triangulated data to determine the concordance of qualitative and quantitative data. RESULTS The study enrolled 40 participants for qualitative interviews and 259 patients for quantitative, with an average age of 16, over half being female, 46% having secondary education, and 96% unmarried. The prevalence of HU use was 78%. The study identified three themes as follows: Patient barriers at the individual including Inadequate knowledge about HU, Persistent pain, Poor adherence to HU, Poor communication with health care workers, and Psychosocial and emotional challenges. At the facility level, long queues and poor quality of care, drug-related side effects that affect HU, and drug stock-outs were reported. Myths, rumors, and misconceptions about HU, and gender-related barriers were reported to affect HU utilization at a community level. Facilitators for the use of HU and recommendations for improvement. Facilitators included perceived benefits, long duration on HU, information sharing by healthcare workers, availability of complementary drugs, confirmation of diagnosis, and availability of medication at public health facilities or private pharmacies. Patients suggested continuous adherence support, encouragement from healthcare workers, sensitization about benefits and risks, a peer-to-peer approach, and financial support for adolescents and women to start businesses to resolve financial problems. CONCLUSION Implementing the use of HU has been challenging in Uganda and needs improvement. Facilitators to hydroxyurea use have been highlighted, though Patient-identified barriers at individual, facility, and community levels that need to be resolved. The experiences and insights shared by our participants provide invaluable guidance for increasing the uptake of HU. Further studies are needed to establish validated instruments to assess patients' pain communication and adherence to the HU regimen.
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Affiliation(s)
| | - Patience Nantume
- Infectious Disease Institute, Makerere University, Kampala, Uganda
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Barak M, Hu C, Matthews A, Fortenberry YM. Current and Future Therapeutics for Treating Patients with Sickle Cell Disease. Cells 2024; 13:848. [PMID: 38786070 PMCID: PMC11120250 DOI: 10.3390/cells13100848] [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: 03/22/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Sickle cell disease (SCD) is the most common genetic blood disorder in the United States, with over 100,000 people suffering from this debilitating disease. SCD is caused by abnormal hemoglobin (Hb) variants that interfere with normal red blood cell (RBC) function. Research on SCD has led to the development and approval of several new SCD therapies in recent years. The recent FDA-approved novel gene therapies are potentially curative, giving patients an additional option besides a hematopoietic bone marrow transplant. Despite the promise of existing therapies, questions remain regarding their long-term pharmacological effects on adults and children. These questions, along with the exorbitant cost of the new gene therapies, justify additional research into more effective therapeutic options. Continual research in this field focuses on not only developing cheaper, more effective cures/treatments but also investigating the physiological effects of the current therapies on SCD patients, particularly on the brain and kidneys. In this article, we undertake a comprehensive review of ongoing clinical trials with completion dates in 2024 or later. Our exploration provides insights into the landscape of current therapeutics and emerging novel therapies designed to combat and potentially eradicate SCD, including the latest FDA-approved gene therapies.
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Affiliation(s)
| | | | | | - Yolanda M. Fortenberry
- Biology Department, Case Western Reserve University, Cleveland, OH 44106, USA; (M.B.); (C.H.); (A.M.)
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Adel AM, Abushanab D, Al-Badriyeh D, Hamad A, Alshurafa A, Yassin MA. Cost-effectiveness of l-glutamine versus crizanlizumab for adults with sickle cell disease: model focused on reducing pain episode costs from Qatar's healthcare perspective. SAGE Open Med 2024; 12:20503121231224551. [PMID: 38711465 PMCID: PMC11072066 DOI: 10.1177/20503121231224551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 12/14/2023] [Indexed: 05/08/2024] Open
Abstract
Objectives Treatment options for preventing vaso-occlusive crises among sickle cell disease patients are on the rise, especially if hydroxyurea treatment has failed. This economic analysis is conducted to assess the comparative clinical effectiveness, safety, and acquisition cost of l-glutamine and crizanlizumab for older adolescents and adults (⩾16 years old) with sickle cell disease in Qatar, with an emphasis on treatment costs and acute pain crises. Methods We conduct a decision-tree model, where we compare the clinical and economic outcomes of two novel Food and drug administration (FDA)-approved medications which are available in Qatar; l-glutamine and crizanlizumab over a time horizon of 1 year in a hypothetical cohort of adult sickle cell disease patients from a Qatar healthcare perspective. The main outcome is incremental cost per sickle cell disease-related acute pain crises averted. Model clinical parameters were derived from individual drug randomized trials, published literature, whereas cost parameters from Qatar healthcare payer system (2020-2021). A sensitivity analysis was carried out, and the study results were robust around model inputs. Costs were converted to 2020 US dollars. Results Study results showed that both treatment modalities' costs were the main driver of this analysis, with an average annual cost of the treatments per patient being $189,014 for crizanlizumab (5 mg/kg), $143,798 for crizanlizumab (2.5 mg/kg), and $74,323 for l-glutamine. The probability of no first-time sickle cell disease-related vaso-occlusive crises averted was 0.001/year for glutamine, 0.26/year for crizanlizumab (5 mg/kg), and 0.34/year for crizanlizumab (2.5 mg/kg). Lower dose crizanlizumab (2.5 mg/kg) dominated the higher one (5 mg/kg). The incremental cost-effectiveness ratio of crizanlizumab (2.5 mg/kg), when compared to l-glutamine was $81,265 per sickle cell disease-related vaso-occlusive crises averted. When comparing crizanlizumab (5 mg/kg) and l-glutamine, crizanlizumab (5 mg/kg) showed higher efficacy, yet the crizanlizumab incremental cost-effectiveness ratio was at $459,620 than l-glutamine. Conclusions Crizanlizumab (2.5 mg/kg) may be a cost-effective intervention, yet it is not the approved dose for preventing vaso-occlusive crises in adolescents and adults with sickle cell disease. Crizanlizumab (5 mg/kg) was more cost-effective than the approved l-glutamine per sickle cell disease vaso-occlusive crisis prevented. Of note, we primarily focused on modeling acute vaso-occlusive pain, which limited our ability to consider other key outcomes in sickle cell disease.
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Affiliation(s)
- Ahmad M Adel
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | | | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Awni Alshurafa
- Hematology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Hematology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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4
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Dudhe MS, Singh A, Ganguly S, Singh C. Hydroxyurea-Induced Cutaneous Ulcers in a Sickle Cell Disease Patient. Indian Dermatol Online J 2024; 15:521-522. [PMID: 38845647 PMCID: PMC11152474 DOI: 10.4103/idoj.idoj_257_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/10/2023] [Accepted: 07/16/2023] [Indexed: 06/09/2024] Open
Affiliation(s)
- Mayur S. Dudhe
- Department of Dermatology, Venereology and Leprosy, Data Meghe Medical College, Nagpur, Maharashtra, India
| | - Ajeet Singh
- Department of Dermatology and Venereology, World College of Medical Sciences and Research, Jhajjar, Haryana, India
| | - Satyaki Ganguly
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Chandan Singh
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Kumaran S, Vetrivelan V, Muthu S, Al-Saadi AA. Computational analysis of anti-cancer drug hydroxyurea adsorption on nanocages of gold, silver and copper: SERS and DFT assessment. Heliyon 2024; 10:e24475. [PMID: 38444468 PMCID: PMC10912048 DOI: 10.1016/j.heliyon.2024.e24475] [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: 11/08/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 03/07/2024] Open
Abstract
The use of nanostructures in targeted drug delivery is effective in decreasing anticancer drug toxicity. Here, we discuss the theoretically predicted adsorption and interaction behavior of hydroxyurea [HU] with nano metal cages (nmC). HU interact the nmC through the N4 in primary amine with energies of -29.776, -30.684 and -22.105 kcal/mol for Au, Ag and Cu cage, respectively. As a result of reactivity studies, HU complexes with nmC (Au/Ag/Cu) are becoming more electrophilic and this gives the nmC system their bioactivity. It is suggested that nanocage is going to change the FMO's energy levels by means of absorption, so that it is used in drug administration. DOS and MEP were accomplished to gain additional understandings into the reactivity of proposed complexes. Method for improving the Raman signal of biomolecules is surface enhanced Raman scattering (SERS), which uses nanosized metal substrates. Chemical enhancement is evidenced by Mulliken charge distributions of all systems for detection and chemical compositions and exerts a significant role in determining them. In HU complexes containing nmC (Au/Ag/Cu), electron density was detected via ELF and LOL calculations. Based on the results of a non-covalent interaction (NCI) analysis, Van der Waals/hydrogen bonds/repulsive steric - interactions have been found. The title compound will also be analyzed in order to determine its bioactivity and drug likeness parameters, as a result, we will able to create a molecule with a highly favorable pharmacological profile and use the docking method to determine the values of the interaction energies for drug delivery. This study suggests that adsorption of drugs on nanocage surface occurs physically and functionalizing the nanocage has increased adsorption energy.
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Affiliation(s)
- S. Kumaran
- Department of ECE, Saveetha Engineering College, Thandalam, Chennai, 602105, Tamilnadu, India
| | - V. Vetrivelan
- Department of Physics, Government College of Engineering, Srirangam, Tiruchirappalli, 620012, Tamilnadu, India
| | - S. Muthu
- Department of Physics, Arignar Anna Govt. Arts College, Cheyyar, 604 407, Tamilnadu, India
| | - Abdulaziz A. Al-Saadi
- Department of Chemistry, King Fahd University of Petroleum & Minerals, Dhahran, 3126, Saudi Arabia
- Interdisciplinary Research Center for Refining and Advanced Chemicals, King Fahd University of Petroleum & Minerals, Dhahran 31261, Saudi Arabia
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Desai G, Dave K, Devare S, Desai S. Ethical and Clinical Considerations in the Use of Hydroxyurea in Pregnant Women with Sickle Cell Disease. Hemoglobin 2024; 48:66-68. [PMID: 38326997 DOI: 10.1080/03630269.2024.2310283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
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Santiago LH, Vargas RB, Pipolo DO, Pan D, Tiwari S, Dehghan K, Bazargan-Hejazi S. Predictors of hospital readmissions in adult patients with sickle cell disease. AMERICAN JOURNAL OF BLOOD RESEARCH 2023; 13:189-197. [PMID: 38223313 PMCID: PMC10784118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most common inherited blood disorder, affecting primarily Black and Hispanic individuals. In 2016, 30-day readmissions incurred 95,445 extra days of hospitalization, $152 million in total hospitalization costs, and $609 million in total hospitalization charges. OBJECTIVES 1) To estimate hospital readmissions within 30 days among patients with SCD in the State of California. 2) Identify the factors associated with readmission within 30 days for SCD patients in California. METHODS We conducted a retrospective observational study of adult SCD patients hospitalized in California between 2005 and 2014. Descriptive statistics and logistic regression models were used to examine significant differences in patient characteristics and their association with hospital readmissions. RESULTS From 2,728 individual index admissions, 70% presented with single admission, 10% experienced one readmission, and 20% experienced ≥ two readmissions within 30 days. Significant predictors associated with zero vs. one readmission were male gender (OR=1.37, CI: 1.06-1.77), Black ethnicity (OR=3.27, CI: 1.71-6.27) and having Medicare coverage (OR=1.89, CI: 1.30-2.75). Lower likelihood of readmission was found in those with a Charlson Comorbidity index of three or more (OR=0.53, CI: 0.29-0.97). For zero vs. ≥ two readmissions, significant predictors were male gender (OR=1.43, CI: 1.17-1.74), Black ethnicity (OR=6.90, CI: 3.41-13.97), Hispanic ethnicity (OR=2.33, CI: 1.05-5.17), Medicare coverage (OR=3.58, CI: 2.68-4.81) and Medi-Cal coverage (OR=1.70, CI: 1.31-2.20). Lower likelihood for having two or more readmissions were associated with individuals aged 65+ (OR=0.97, CI: 0.96-0.98) and those with self-payment status (OR=0.32, CI: 0.12-0.54). CONCLUSIONS In California, male, Black, and Hispanic patients, as well as those covered by Medicare or Medi-Cal, were found to have an increased risk of hospital readmissions. Redirecting outpatient goals to address these patient populations and risk factors is crucial for reducing readmission rates.
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Affiliation(s)
- Laura H Santiago
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
- David Geffen School of Medicine, UCLALos Angeles, CA, USA
| | - Roberto B Vargas
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
- David Geffen School of Medicine, UCLALos Angeles, CA, USA
| | - Derek O Pipolo
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Deyu Pan
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Sweta Tiwari
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Kaveh Dehghan
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and ScienceLos Angeles, CA, USA
- David Geffen School of Medicine, UCLALos Angeles, CA, USA
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8
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Hankins JS, Brambilla D, Potter MB, Kutlar A, Gibson R, King AA, Baumann AA, Melvin C, Gordeuk VR, Hsu LL, Nwosu C, Porter JS, Alberts NM, Badawy SM, Simon J, Glassberg JA, Lottenberg R, DiMartino L, Jacobs S, Fernandez ME, Bosworth HB, Klesges LM, Shah N. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease. Blood Adv 2023; 7:7190-7201. [PMID: 37738155 PMCID: PMC10698253 DOI: 10.1182/bloodadvances.2023010670] [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: 05/08/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
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Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Robert Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Allison A King
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victor R Gordeuk
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jena Simon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Sara Jacobs
- RTI International, Research Triangle Park, NC
| | - Maria E Fernandez
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hayden B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center, Durham, NC
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Nirmish Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC
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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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Deenadayalan V, Litvin R, Vakil J, Kanemo P, Shaka H, Venkataramanan A, Zia M. Recent national trends in outcomes and economic disparities among adult sickle cell disease-related admissions. Ann Hematol 2023; 102:2659-2669. [PMID: 37522971 DOI: 10.1007/s00277-023-05388-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
Sickle cell disease (SCD) is an inherited disorder caused secondary to a mutation in the hemoglobin beta subunit. There is sparse information regarding the trends in outcomes of SCD admissions in the past decade where rapid advances have been made in treatment. In this study, we wanted to analyze the trends and outcomes of SCD admissions in the United States from 2011 to 2019 and the influence of socio-economic status. Data were obtained from the National Inpatient Sample (NIS) database using the International Classification of Disease (ICD-9) and ICD-10 codes. Trends for primary in-hospital outcomes including mortality, length of stay (LOS), and total hospitalization charges (THC) were assessed. The impact of economic status on these outcomes was also studied. There was an annual percent change (APC) in the number of admissions for SCD of + 2.5% from 2010 to 2015 (95% CI: 1.3-3.8%, p = 0.003). However, there was no significant change in the number of admissions between 2015 and 2019 (95% CI - 1.8-0.7%, p = 0.323). The overall mortality across the years has decreased by about 4% yearly at the population level (p = 0.008, 95% CI 2-8%). However, the inpatient mortality for the high-income group had decreased significantly from 2010 to 2019, whereas there was no difference in the mortality rate for the low-income group across the decade. Despite the advances in the understanding of SCD and its treatment, its benefits have not reached all the people affected. Meaningful progress in healthcare is not achievable unless these economic disparities are addressed. Economic policies to address these inequities are the need of the hour.
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Affiliation(s)
- Vaishali Deenadayalan
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA.
| | - Rafaella Litvin
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Jay Vakil
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Philip Kanemo
- Department of Hospital Medicine, Rapides Regional Medical Center, Alexandria, LA, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Akash Venkataramanan
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Maryam Zia
- Department of Hematology/Oncology, John H Stroger Hospital of Cook County, Chicago, IL, USA
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Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris IM, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong K. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol 2023; 10:e633-e686. [PMID: 37451304 DOI: 10.1016/s2352-3026(23)00096-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence for Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Brigitte Ranque
- Department of Internal Medicine, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris Centre, University of Paris Cité, Paris, France
| | - Alexis A Thompson
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, and Sickle Cell Program, American University of Beirut, Beirut, Lebanon
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC, USA
| | - Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Connecticut, USA
| | - Roshan Colah
- Department of Haematogenetics, Indian Council of Medical Research National Institute of Immunohaematology, Mumbai, India
| | - Raffaella Colombatti
- Pediatric Oncology Hematology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Conran
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Fernando F Costa
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mariane de Montalembert
- Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris Centre, Paris, France
| | - Jacques Elion
- Paris Cité University and University of the Antilles, Inserm, BIGR, Paris, France
| | - Erica Esrick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anthea L Greenway
- Department Clinical Haematology, Royal Children's Hospital, Parkville and Department Haematology, Monash Health, Clayton, VIC, Australia
| | - Ibrahim M Idris
- Department of Hematology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - David-Zacharie Issom
- Department of Business Information Systems, School of Management, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zane S Kaplan
- Department of Clinical Haematology, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Allison A King
- Departments of Pediatrics and Internal Medicine, Divisions of Pediatric Hematology and Oncology and Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - Michele Lloyd-Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leon Tshilolo
- Institute of Biomedical Research/CEFA Monkole Hospital Centre and Official University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Kwaku Ohene-Frempong
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania, USA; Sickle Cell Foundation of Ghana, Kumasi, Ghana
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Cannas G, Poutrel S, Heiblig M, Labussière H, Larcher MV, Thomas X, Hot A. Sickle cell disease and acute leukemia: one case report and an extensive review. Ann Hematol 2023:10.1007/s00277-023-05294-3. [PMID: 37269388 DOI: 10.1007/s00277-023-05294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
Population-based studies and case reports suggest that there may be an increased risk of acute leukemia associated with sickle cell disease (SCD). Following the description of a new case report, an extensive review of the literature identified 51 previously described cases. Most cases study showed myelodysplastic features confirmed, when available, by genetic markers such as chromosome 5 and/or chromosome 7 abnormalities and TP53 gene mutations. The increased risk of leukemogenesis is certainly multifactorial and related to the pathophysiologic mechanisms of the clinical manifestations of SCD. Chronic hemolysis and secondary hemochromatosis may cause increased chronic inflammation, resulting in persistent marrow stress, which could potentially compromise the genomic stability of the hematopoietic stem cells generating genomic damage and somatic mutations over the course of SCD and its treatment, resulting in a clone that led to acute myeloid leukemia.
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Affiliation(s)
- Giovanna Cannas
- Internal Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d'Arsonval, Lyon cedex 03, 69437, Lyon, France.
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France.
| | - Solène Poutrel
- Internal Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d'Arsonval, Lyon cedex 03, 69437, Lyon, France
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France
| | - Maël Heiblig
- Hematology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Hélène Labussière
- Hematology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | | | - Xavier Thomas
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France
| | - Arnaud Hot
- Internal Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d'Arsonval, Lyon cedex 03, 69437, Lyon, France
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France
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13
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Oyedeji CI, Hodulik KL, Telen MJ, Strouse JJ. Management of Older Adults with Sickle Cell Disease: Considerations for Current and Emerging Therapies. Drugs Aging 2023; 40:317-334. [PMID: 36853587 PMCID: PMC10979738 DOI: 10.1007/s40266-023-01014-8] [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] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
People with sickle cell disease (SCD) are living longer than ever before, with the median survival increasing from age 14 years in 1973, beyond age 40 years in the 1990s, and as high as 61 years in recent cohorts from academic centers. Improvements in survival have been attributed to initiatives, such as newborn screening, penicillin prophylaxis, vaccination against encapsulated organisms, better detection and treatment of splenic sequestration, and improved transfusion support. There are an estimated 100,000 people living with SCD in the United States and millions of people with SCD globally. Given that the number of older adults with SCD will likely continue to increase as survival improves, better evidence on how to manage this population is needed. When managing older adults with SCD (defined herein as age ≥ 40 years), healthcare providers should consider the potential pitfalls of extrapolating evidence from existing studies on current and emerging therapies that have typically been conducted with participants at mean ages far below 40 years. Older adults with SCD have historically had little to no representation in clinical trials; therefore, more guidance is needed on how to use current and emerging therapies in this population. This article summarizes the available evidence for managing older adults with SCD and discusses potential challenges to using approved and emerging drugs in this population.
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Affiliation(s)
- Charity I Oyedeji
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA.
| | - Kimberly L Hodulik
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Marilyn J Telen
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA
- Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
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14
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Tonin FS, Ginete C, Ferreira J, Delgadinho M, Santos B, Fernandez-Llimos F, Brito M. Efficacy and safety of pharmacological interventions for managing sickle cell disease complications in children and adolescents: Systematic review with network meta-analysis. Pediatr Blood Cancer 2023; 70:e30294. [PMID: 36916826 DOI: 10.1002/pbc.30294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
This study aimed to synthesize the evidence on the effects of disease-modifying agents for managing sickle cell disease (SCD) in children and adolescents by means of a systematic review with network meta-analyses, surface under the cumulative ranking curve (SUCRA) and stochastic multicriteria acceptability analyses (SMAA) (CRD42022328471). Eightteen randomized controlled trials (hydroxyurea [n = 7], l-arginine [n = 3], antiplatelets [n = 2], immunotherapy/monoclonal antibodies [n = 2], sulfates [n = 2], docosahexaenoic acid [n = 1], niprisan [n = 1]) were analyzed. SUCRA and SMAA demonstrated that hydroxyurea at higher doses (30 mg/kg/day) or at fixed doses (20 mg/kg/day) and immunotherapy/monoclonal antibodies are more effective for preventing vaso-occlusive crisis (i.e., lower probabilities of incidence of this event; 14, 25, and 30%, respectively), acute chest syndrome (probabilities ranging from 8 to 30%), and needing of transfusions (11-31%), while l-arginine (100-200 mg/kg) and placebo were more prone to these events. Therapies were overall considered safe; however, antiplatelets and sulfates may lead to more severe adverse events. Although the evidence was graded as insufficient and weak, hydroxyurea remains the standard of care for this population, especially if a maximum tolerated dose schedule is considered.
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Affiliation(s)
- Fernanda S Tonin
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Catarina Ginete
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Joana Ferreira
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Mariana Delgadinho
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Bengo, Angola.,Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola
| | - Fernando Fernandez-Llimos
- CINTESIS@RISE, Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Miguel Brito
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
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15
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Costa SA, Ribeiro CCC, Thomaz EBAF, Costa CPS, Souza SDFC. Mechanisms underlying the adaptive pulp and jaw bone trabecular changes in sickle cell anemia. Oral Dis 2023; 29:786-795. [PMID: 34369045 DOI: 10.1111/odi.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS. METHODS This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age. RESULTS The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02). CONCLUSION Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.
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Hankins JS, Potter MB, Fernandez ME, Melvin C, DiMartino L, Jacobs SR, Bosworth HB, King AA, Simon J, Glassberg JA, Kutlar A, Gordeuk VR, Shah N, Baumann AA, Klesges LM. Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease. FRONTIERS IN HEALTH SERVICES 2023; 2:1024541. [PMID: 36925803 PMCID: PMC10012741 DOI: 10.3389/frhs.2022.1024541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/09/2022] [Indexed: 01/22/2023]
Abstract
Background Sickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes. Methods During 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation. Results Behavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes. Discussion Our research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.
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Affiliation(s)
- J. S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - M. B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States
- Clinical, Family, and Community Medicine, University of California San Francisco, CA, United States
| | - M. E Fernandez
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center, School of Public Health at Houston, Houston, TX, United States
| | - C Melvin
- The Medical University of South Carolina, Charleston, SC, United States
| | - L DiMartino
- RTI International, Research triangle park, NC, United States
| | - S. R Jacobs
- RTI International, Research triangle park, NC, United States
| | - H. B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - A. A King
- Department of Pediatrics, Washington University, Saint louis, MO, United States
| | - J Simon
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - J. A Glassberg
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - A Kutlar
- Augusta University, Augusta, GA, United States
| | - V. R Gordeuk
- Department of Medicine, the University of Illinois at Chicago, Chicago, IL, United States
| | - N Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC, United States
| | - A. A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
| | - L. M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
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17
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Sridevi P, Sharma Y, Balakrishna SL, Babu BV. Sickle cell disease treatment and management in India: a systematic review of interventional studies. Trans R Soc Trop Med Hyg 2022; 116:1101-1111. [PMID: 36227060 DOI: 10.1093/trstmh/trac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Sickle cell disease (SCD) affects approximately 5% of the world's population, and India has been the second highest country in the numbers of predicted SCD births. Despite the high burden in India, there is no state-led public health programme, and very few interventions dealing with the treatment and management of SCD are available. This review highlights the dearth of SCD-related interventions, and demonstrates that these interventions effectively improve patients' conditions and are feasible to implement in India. We systematically searched three databases-PubMed/Medline, Google Scholar and Web of Science-for articles from India on SCD-related interventions. The PRISMA guidelines were followed during this review. We included 22 studies, of which 19 dealt with specific therapeutic interventions, and 3 with comprehensive SCD care. Hydroxyurea therapy was the main therapy in 15 studies and is efficacious. Three studies demonstrated the feasibility of comprehensive care in resource-limited settings. The low number of SCD-related intervention studies does not match the huge burden of SCD in India. Governments of endemic countries should consider the findings of available interventions and include them in their countries' programmes. Comprehensive care is feasible in India and other low-resource settings, from screening to treatment and psychosocial support.
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Affiliation(s)
- Parikipandla Sridevi
- D epartment of Biot echnology, Indira Gandhi National Tribal University, Amarkantak, India
| | - Yogita Sharma
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Sunnam L Balakrishna
- D epartment of Biot echnology, Indira Gandhi National Tribal University, Amarkantak, India.,Department of Biochemistry & Molecular Biology, Central University of Kerala, Periye, India
| | - Bontha V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
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18
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Kalshetti RG, Rajput R, Motiwala Z, Srinivasa Reddy D, Kulkarni KA, Ramana CV. Postmodification of voxelotor (GBT 440) via [Rh]-catalyzed cross dehydrogenative coupling with olefins. Bioorg Med Chem Lett 2022; 77:129022. [DOI: 10.1016/j.bmcl.2022.129022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/24/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
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Dayer LE, Wagner R, King D, Lakkad M, Wilson LA, Montgomery C, Painter JT. Impact of Hydroxyurea Starting Dose on Pain Outcomes in Patients with Sickle Cell Disease. J Pain Palliat Care Pharmacother 2022; 36:223-227. [PMID: 36688614 DOI: 10.1080/15360288.2022.2128154] [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: 01/12/2023]
Abstract
In patients with sickle cell disease, hydroxyurea decreases the number of pain crises experienced. This study aimed to evaluate the difference in pain outcomes between patients started on a guideline concordant, weight-based starting dose of at least 15 mg/kg/day of hydroxyurea and those not. The first prescription of hydroxyurea was the baseline date, follow-up was a visit 60-120 days after baseline. The primary outcome was the change in opioid prescribing between baseline and follow-up. 138 patients met inclusion criteria; of these, 55 were started on a guideline concordant dose of hydroxyurea. Greater white blood cell count (9.5 vs 12.0; p < 0.01) was statistically associated with subtherapeutic dosing. Greater actual body weight (68.0 vs 72.1 kg; p = 0.16) also appeared higher in the non-guideline concordant group. No statistically significant difference in opioid prescribing was observed between those started on a guideline concordant dose of hydroxyurea and those who were not. In the guideline concordant starting dose group, 42% had a reduction in pain scores at first follow up, compared to 35% with a non-guideline recommended starting dose. (p = 0.41). While this difference is in the direction that would be expected based on the guidelines, the difference does not appear to be clinically meaningful.
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20
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Crossley M, Christakopoulos GE, Weiss MJ. Effective therapies for sickle cell disease: are we there yet? Trends Genet 2022; 38:1284-1298. [PMID: 35934593 PMCID: PMC9837857 DOI: 10.1016/j.tig.2022.07.003] [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: 04/11/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/24/2023]
Abstract
Sickle cell disease (SCD) is a common genetic blood disorder associated with acute and chronic pain, progressive multiorgan damage, and early mortality. Recent advances in technologies to manipulate the human genome, a century of research and the development of techniques enabling the isolation, efficient genetic modification, and reimplantation of autologous patient hematopoietic stem cells (HSCs), mean that curing most patients with SCD could soon be a reality in wealthy countries. In parallel, ongoing research is pursuing more facile treatments, such as in-vivo-delivered genetic therapies and new drugs that can eventually be administered in low- and middle-income countries where most SCD patients reside.
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Affiliation(s)
- Merlin Crossley
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia 2052.
| | | | - Mitchell J Weiss
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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21
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Zhu J, Li H, Aerbajinai W, Kumkhaek C, Pirooznia M, Saxena A, Dagur P, Chin K, Rodgers GP. Kruppel-like factor 1-GATA1 fusion protein improves the sickle cell disease phenotype in mice both in vitro and in vivo. Blood 2022; 140:2276-2289. [PMID: 36399071 PMCID: PMC9837447 DOI: 10.1182/blood.2021014877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Sickle cell disease (SCD) and β-thalassemia are among the most common genetic disorders worldwide, affecting global health and mortality. Hemoglobin A2 (HbA2, α2δ2) is expressed at a low level in adult blood due to the lack of the Kruppel-like factor 1 (KLF1) binding motif in the δ-globin promoter region. However, HbA2 is fully functional as an oxygen transporter, and could be a valid antisickling agent in SCD, as well as a substitute for hemoglobin A in β-thalassemia. We have previously demonstrated that KLF1-GATA1 fusion protein could interact with the δ-globin promoter and increase δ-globin expression in human primary CD34+ cells. We report the effects of 2 KLF1-GATA1 fusion proteins on hemoglobin expression, as well as SCD phenotypic correction in vitro and in vivo. Forced expression of KLF1-GATA1 fusion protein enhanced δ-globin gene and HbA2 expression, as well as reduced hypoxia-related sickling, in erythroid cells cultured from both human sickle CD34+ cells and SCD mouse hematopoietic stem cells (HSCs). The fusion proteins had no impact on erythroid cell differentiation, proliferation, and enucleation. Transplantation of highly purified SCD mouse HSCs expressing KLF1-GATA1 fusion protein into SCD mice lessened the severity of the anemia, reduced the sickling of red blood cells, improved SCD-related pathological alterations in spleen, kidney, and liver, and restored urine-concentrating ability in recipient mice. Taken together, these results indicate that the use of KLF1-GATA1 fusion constructs may represent a new gene therapy approach for hemoglobinopathies.
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Affiliation(s)
- Jianqiong Zhu
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Hongzhen Li
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Wulin Aerbajinai
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Chutima Kumkhaek
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mehdi Pirooznia
- Bioinformatics and Systems Biology Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ankit Saxena
- Flow Cytometry Core Facility, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Pradeep Dagur
- Flow Cytometry Core Facility, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Kyung Chin
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Griffin P. Rodgers
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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22
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Cutaneous manifestations of sickle cell disease: an updated review. Arch Dermatol Res 2022; 315:729-734. [PMID: 36416981 DOI: 10.1007/s00403-022-02466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
Sickle cell disease is a common and highly morbid genetic condition that is characterized by multi-system involvement, including numerous cutaneous manifestations. Persistent and recurrent leg ulceration has long been considered the dermatological hallmark of those with sickle cell disease, but there have been recent descriptions of associated infection with rare pathogens and episodes of liverdoid vasculopathy. Growing considerations for this population in the literature include cutaneous reactions to common treatments such as hydroxyurea and clinical management of the intersection between sickle cell disease and conditions like plaque psoriasis. Recent studies have also demonstrated an increased resistance to skin carcinogenesis for those with sickle cell disease through unclear mechanisms. However, though the body of knowledge regarding cutaneous manifestations and considerations of sickle cell disease is slowly expanding, it does not match the considerable disease and symptom burden faced by these patients. More research is needed to better delineate our understanding of these cutaneous manifestations of sickle cell disease to improve outcomes and further management.
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23
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Kadhim MM, Jihad A, Hachim SK, Abdullaha SAH, Taban TZ, Rheima AM. A molecular modeling on the potential application of beryllium oxide nanotube for delivery of hydroxyurea anticancer drug. J Mol Model 2022; 28:357. [PMID: 36222931 DOI: 10.1007/s00894-022-05343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/29/2022] [Indexed: 12/01/2022]
Abstract
Within this work, we scrutinized the use of BeO nanotube (BeONT) as a nanocarrier for the anticancer drug hydroxyurea (HU) through density functional theory (DFT) calculations. We utilized the functional ꞷB97XD and the basis set 6-31G**. Based on a detailed surface analysis, HU was adsorbed on the surface of the nanotube through 4 different orientations. Also, no vibrational spectra exhibited imaginary frequencies, showing the minimum energy of the relaxed structures. The maximum adsorption energy and the minimum adsorption energy are in strong physical adsorption. The BeONT exhibited p-type semiconducting characteristics in all orientations since it received electronic charge from HU. The results demonstrate the possibility of using the BeONT as a promising carrier for HU drugs.
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Affiliation(s)
- Mustafa M Kadhim
- Medical Laboratory Techniques Department, Al-Farahidi University, Baghdad, 10022, Iraq.
| | - Ali Jihad
- Pharmacy Department, Al-Mustaqbal University College, Hilla, 51001, Iraq
| | - Safa K Hachim
- College of Technical Engineering, The Islamic University, Najaf, Iraq.,Medical Laboratory Techniques Department, Al-Turath University College, Baghdad, Iraq
| | | | - Taleeb Zedan Taban
- Laser and Optoelectronics Engineering Department, Kut University College, Kut, Wasit, Iraq
| | - Ahmed Mahdi Rheima
- Department of Chemistry, College of Science, Mustansiriyah University, Baghdad, Iraq
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24
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Mathematical Modeling of Hydroxyurea Therapy in Individuals with Sickle Cell Disease. Pharmaceutics 2022; 14:pharmaceutics14051065. [PMID: 35631651 PMCID: PMC9144420 DOI: 10.3390/pharmaceutics14051065] [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: 03/13/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
Sickle cell disease (SCD) is a chronic hemolytic anemia affecting millions worldwide with acute and chronic clinical manifestations and early mortality. While hydroxyurea (HU) and other treatment strategies managed to ameliorate disease severity, high inter-individual variability in clinical response and a lack of an ability to predict those variations need to be addressed to maximize the clinical efficacy of HU. We developed pharmacokinetics (PK) and pharmacodynamics (PD) models to study the dosing, efficacy, toxicity, and clinical response of HU treatment in more than eighty children with SCD. The clinical PK parameters were used to model the HU plasma concentration for a 24 h period, and the estimated daily average HU plasma concentration was used as an input to our PD models with approximately 1 to 9 years of data connecting drug exposure with drug response. We modeled the biomarkers mean cell volume and fetal hemoglobin to study treatment efficacy. For myelosuppression, we modeled red blood cells and absolute neutrophil count. Our models provided excellent fits for individuals with known or correctly inferred adherence. Our models can be used to determine the optimal dosing regimens and study the effect of non-adherence on HU-treated individuals.
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25
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Dawson A, Mullen K, Janson IA, Henriksen B, Duncan N, O'Brien D, Meier ER. A Feasibility Pilot Study of Online Modules of Hydroxyurea and Sickle Cell Disease Care for Adolescents and Young Adults for Family Medicine Residents. J Pediatr Hematol Oncol 2022; 44:e313-e318. [PMID: 34054051 DOI: 10.1097/mph.0000000000002224] [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] [Received: 01/15/2021] [Accepted: 04/30/2021] [Indexed: 01/19/2023]
Abstract
Family medicine (FP) residency programs are located throughout Indiana, and most adults with sickle cell disease (SCD) in Indiana have access to a primary care clinic administered by a FP program. Allen County ranks third in SCD incidence in Indiana, but has few providers for adolescents, young adults (AYAs) and adults with SCD. Initiation of a novel partnership between Indianapolis-based adult hematologists (130 miles distant), and the FP program in Allen County aimed to educate FP residents about SCD, hydroxyurea, transition, and SCD complications. To determine the feasibility of utilizing online learning modules to educate FP residents about SCD care in AYA and adults, 3 online learning modules (comprehensive care of AYAs with SCD, hydroxyurea, and best practices in AYA transition) were developed and continuing medical education-accredited. Electronic pretest and posttest were distributed to 32 FP residents to test the retention of content through an Institutional Review Board approved protocol. This pilot study demonstrates that it is feasible to utilize online educational modules to educate providers about SCD care.
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Affiliation(s)
| | | | - Isaac A Janson
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | | | - Natalie Duncan
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | - Dennis O'Brien
- Pediatric Hematology/Oncology, Lutheran Children's Hospital, Fort Wayne
| | - Emily R Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
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26
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Qin Y, Wu X, Zhou N, Xu H, Tan J, Chen X, Peng Z, Nie C. The simulation study of transport performance of HU drugs on functionalized graphene nanosheets based on the Density Functional Theory. COMPUT THEOR CHEM 2022. [DOI: 10.1016/j.comptc.2022.113604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Tolu SS, Crouch A, Choi J, Gao Q, Reyes-Gil M, Ogu UO, Vinces G, Minniti CP. Hydroxyurea and fetal hemoglobin effect on leg ulcers in patients with sickle cell disease. Ann Hematol 2022; 101:541-548. [PMID: 35039901 DOI: 10.1007/s00277-021-04635-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/14/2021] [Indexed: 11/01/2022]
Abstract
The presence of leg ulcers in individuals with sickle cell disease often represents an early sign of vasculopathy and future end organ damage. Pathophysiological mechanisms of formation and evolution of leg ulcers are poorly understood; nevertheless, HbF has been associated with lower incidence of leg ulcers, while hydroxyurea has been correlated with high risk of leg ulcers. As a result, there is hesitation regarding hydroxyurea use in patients with SCD and leg ulcers. In this study, we aim to define (1) a target of HbF that offers protection against leg ulcer development and (2) the impact of hydroxyurea therapy on leg ulcer prevalence. Our study demonstrated that in order to reduce leg ulcer incidence by one-third, a HbF > 25% is needed, a threshold not commonly reached and maintained in the adult SCD population. Importantly, leg ulcer incidence appears to be independent of HU use (p = 0.50). Our interpretation of this data is that the use of HU in a patient with SCD and leg ulcers should be guided by a careful assessment of risks and benefits of this therapeutic modality.
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Affiliation(s)
- Seda S Tolu
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th street, Bronx, NY, 10467, USA.
| | - Andrew Crouch
- Department of Medicine, Division of Hematology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jaeun Choi
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qi Gao
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Moramaya Reyes-Gil
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Ugochi Olivia Ogu
- Department of Medicine, Division of Hematology/Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Giacomo Vinces
- Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Caterina P Minniti
- Department of Medicine, Division of Hematology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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28
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Ribeil J. Primary myelofibrosis in untreated sickle cell disease: Are adult patients at higher risk for developing hematological myeloid neoplasms? Am J Hematol 2022; 97:4-6. [PMID: 34626435 DOI: 10.1002/ajh.26371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Jean‐Antoine Ribeil
- Section of Hematology/Oncology, Boston University and Boston Medical Center; Sickle Cell Center, Boston University School of Medicine Boston Massachusetts USA
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29
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Santana JERS, Baptista AF, Lucena R, Lopes TDS, do Rosário RS, Xavier MR, Fonseca A, Miranda JGV. Altered Dynamic Brain Connectivity in Individuals With Sickle Cell Disease and Chronic Pain Secondary to Hip Osteonecrosis. Clin EEG Neurosci 2021; 54:333-342. [PMID: 34779267 DOI: 10.1177/15500594211054297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals with sickle cell disease (SCD) exhibit changes in static brain connectivity in rest. However, little known as chronic pain associated with hip osteonecrosis affects dynamic brain connectivity during rest and the motor imagery task. The aim of this study was to investigate the characteristics of the dynamic functional brain connectivity of individuals with SCD and chronic pain secondary to hip osteonecrosis. This is a cross-sectional study comparing the dynamic brain connectivity of healthy individuals (n = 18) with the dynamic brain connectivity of individuals with SCD and chronic pain (n = 22). Individuals with SCD and chronic pain were stratified into high- or low-intensity pain groups based on pain intensity at the time of assessment. Dynamic brain connectivity was assessed through electroencephalography in 3 stages, resting state with eyes closed, and during hip (painful for the SCD individuals) and hand (control, nonpainful) motor imagery. Average weight of the edges and full synchronization time (FST)-time required for 95% of the possible edges to appear over time during a given task-were evaluated. Regarding the average weight of the edges, individuals with SCD and high-intensity pain presented higher edge weight during hip motor imagery. The average weight of the edges correlated positively with pain intensity and depression symptoms. Individuals with SCD and chronic pain complete the cerebral network at rest more quickly (lower FST). Individuals with SCD and chronic pain/hip osteonecrosis have impaired dynamic brain network with shorter FST in rest network and more pronounced diffuse connectivity in individuals with high-intensity pain. The dynamic brain network evaluated by time-varying graphs and motif synchronization was able to identify differences between groups.
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Affiliation(s)
- Jamille Evelyn R S Santana
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil
| | - Abrahão F Baptista
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil.,Center for Mathematics, Computation and Cognition, 488583Federal University of ABC, Santo Andre, Brazil
| | - Rita Lucena
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil.,Medical School of Bahia, 28111Federal University of Bahia, Salvador, Brazil
| | - Tiago da S Lopes
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, 28111Federal University of Bahia, Salvador, Brazil.,Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
| | - Raphael S do Rosário
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Institute of Physics, Federal University of Bahia, Salvador, Brazil
| | - Marjorie R Xavier
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil
| | - André Fonseca
- Center for Mathematics, Computation and Cognition, 488583Federal University of ABC, Santo Andre, Brazil
| | - José Garcia V Miranda
- Health and Functionality Study Group, 28111Federal University of Bahia, Salvador, Brazil.,Institute of Physics, Federal University of Bahia, Salvador, Brazil
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30
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Booth A, Bonham V, Porteus M, Ormond KE. Treatment decision-making in sickle cell disease patients. J Community Genet 2021; 13:143-151. [PMID: 34735685 DOI: 10.1007/s12687-021-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
Sickle cell disease (SCD) is a blood disorder with few treatment options currently available. However, in recent years, there has been much progress toward developing new therapies and curative treatments to help patients with SCD. Stem cell transplant remains the only approved curative treatment for SCD, but new clinical trials are being initiated using gene therapy and gene editing. We surveyed patients with sickle cell disease (N=9) about attitudes toward stem cell transplant, gene therapy to add a new healthy gene, gene editing to up-regulate fetal hemoglobin, or gene editing to correct the point mutation. The participants read a fact sheet that included objective information on each curative treatment. When asked which curative treatment each participant would choose, all four options were selected at least once. The most highly selected treatment was gene correction gene editing (N=4). Participants generally agreed that the four treatment options are beneficial but were more mixed in their thoughts on whether the options are dangerous. Reasons for selecting a particular curative treatment were variable, but the most selected reasons were perception of a cure (N=4) or decreased severity (N=4), and not needing a donor (N=4). We are at the beginning stages of understanding how patients with SCD make decisions about curative treatments. Currently, patients may be interested in any of the four possibilities for curative treatments, with gene correction gene editing as the most popular choice. Reasons for choosing one treatment over another are mixed.
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Affiliation(s)
- A Booth
- Department of Genetics, Stanford School of Medicine, Stanford, CA, USA
| | - V Bonham
- National Human Genome Research Institute, Bethesda, MD, USA
| | - M Porteus
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - K E Ormond
- Department of Genetics, Stanford School of Medicine, Stanford, CA, USA. .,Stanford Center for Biomedical Ethics, Stanford School of Medicine, Stanford, CA, USA.
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31
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Montalembert M, Voskaridou E, Oevermann L, Cannas G, Habibi A, Loko G, Joseph L, Colombatti R, Bartolucci P, Brousse V, Galactéros F. Real-Life experience with hydroxyurea in patients with sickle cell disease: Results from the prospective ESCORT-HU cohort study. Am J Hematol 2021; 96:1223-1231. [PMID: 34224583 DOI: 10.1002/ajh.26286] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
Several controlled studies have evidenced good efficacy and short-term and mid-term safety profiles for hydroxyurea (HU), which has become the cornerstone for prevention of sickle-cell disease (SCD)-related vaso-occlusive crises. However, there are few large-scale reports on its long-term use and certain caregivers and patients have concerns about its safety. Following the licensing of HU in Europe for children and adults with severe forms of SCD, ESCORT-HU was designed as a Phase IV observational cohort study. It included 1906 participants, of whom 55% were adults. The most common hemoglobin (Hb) genotypes were HbSS (84.7%) and HbSβ+ (7.0%). The median duration of follow-up was 45 months, for a total of 7309 patient-years of observation. The dose of HU after 1 year was 20.6 mg/kg/d for children and 16.3 mg/kg/d for adults. There was a statistically significant decrease in the number of vaso-occlusive episodes lasting >48 h, acute chest syndrome episodes, hospitalizations, and the percentage of patients requiring blood transfusions within the first 12 months relative to the year before enrolment. Neutropenia and thrombocytopenia were the most commonly reported adverse effects. No new HU toxicity was identified. Overall, 125 pregnancies were reported in 101 women and no malformations were observed in the neonates. There were 12 pregnancies for partners of male patients treated with HU. One case of fatal myelodysplastic syndrome was reported, for which a causal association with HU could not be excluded. This cohort study of patients with SCD highlights the positive benefit-to-risk ratio of HU in children and adults.
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Affiliation(s)
- Mariane Montalembert
- Reference Centre for Sickle Cell Disease, Department of General Pediatrics and Pediatric Infectious Diseases Necker‐Enfants malades Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris France
| | - Ersi Voskaridou
- Centre of Excellence in Rare Hematological Disease‐Hemoglobinopathies, Laiko General Hospital Athens Greece
| | - Lena Oevermann
- Department of Pediatric Oncology & Hematology Charité University Medicine, Berlin and Berlin Institute of Health Berlin Germany
| | - Giovanna Cannas
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Médecine Interne, Centre de Référence Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse Lyon France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
| | - Gylna Loko
- Centre hospitalier de la Martinique Fort‐de‐France Martinique France
| | - Laure Joseph
- Biotherapy Department Necker Children's Hospital, Assistance Publique‐Hôpitaux de Paris Paris France
| | | | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Department of General Pediatrics and Pediatric Infectious Diseases Necker‐Enfants malades Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
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32
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Suspected Severe Malaria in a Sudanese Patient Affected by Sickle Cell Disease Who Was Treated with Hydroxyurea. Pathogens 2021; 10:pathogens10080985. [PMID: 34451449 PMCID: PMC8398986 DOI: 10.3390/pathogens10080985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
Sickle cell disease (SCD) is the most common genetic disease in sub-Saharan Africa. The signs and symptoms of SCD usually begin in early childhood. Characteristic features of this disorder include anaemia, repeated infections, and periodic episodes of pain. Malaria is one of the infections that can occur in patients with SCD in endemic countries. Many guidelines recommend antimalarial chemoprophylaxis in these patients, although the debate on which drug should be used is still ongoing. Hydroxyurea (HU), which is considered a safe and effective treatment for both children and adults with SCD, seems to affect the incidence and severity of malaria, although these impacts have yet to be fully demonstrated. We report a case of an eight-and-a-half-year-old Sudanese boy with SCD treated with HU admitted for suspected severe malaria who showed a recrudescence after first-line treatment. Although he had undergone splenectomy and thus belonged to a category of patients at high risk for infectious complications, he was not receiving any malaria chemoprophylaxis. This case emphasises the importance of the routine administration of malaria prophylaxis to children with SCD living in endemic areas, even when they are treated with HU, and especially if they are at high risk for infectious complications because they have undergone splenectomy. There is an urgent need for further research to evaluate the most appropriate regimen and its optimal duration.
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33
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Fan X, Zhu Y, Wang N, Zhang B, Zhang C, Wang Y. Therapeutic Dose of Hydroxyurea-Induced Synaptic Abnormalities on the Mouse Spermatocyte. Front Physiol 2021; 12:666339. [PMID: 34305635 PMCID: PMC8299468 DOI: 10.3389/fphys.2021.666339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/14/2021] [Indexed: 12/30/2022] Open
Abstract
Hydroxyurea (HU) is a widely used pharmacological therapy for sickle cell disease (SCD). However, replication stress caused by HU has been shown to inhibit premeiotic S-phase DNA, leading to reproductive toxicity in germ cells. In this study, we administered the therapeutic doses of HU (i.e., 25 and 50 mg/kg) to male mice to explore whether replication stress by HU affects pachytene spermatocytes and causes the abnormalities of homologous chromosomes pairing and recombination during prophase I of meiosis. In comparison with the control group, the proportions of spermatocyte gaps were significantly different in the experimental groups injected with 25 mg/kg (p < 0.05) and 50 mg/kg of HU (p < 0.05). Moreover, the proportions of unrepaired double-stranded breaks (DSBs) observed by γH2AX staining also corresponded to a higher HU dose with a greater number of breaks. Additionally, a reduction in the counts of recombination foci on the autosomal SCs was observed in the pachytene spermatocytes. Our results reveal that HU has some effects on synaptonemal complex (SC) formation and DSB repair which suggest possible problems in fertility. Therefore, this study provides new evidence of the mechanisms underlying HU reproductive toxicity.
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Affiliation(s)
- Xiaobo Fan
- Laboratory of Molecular Cytogenetics, School of Bioengineering, Xuzhou University of Technology, Xuzhou, China
| | - Yunxia Zhu
- The Center of Reproductive Medicine, Xuzhou Maternity and Child Health Care Hospital, Xuzhou, China
| | - Naixin Wang
- Laboratory of Molecular Cytogenetics, School of Bioengineering, Xuzhou University of Technology, Xuzhou, China
| | - Bing Zhang
- Laboratory of Molecular Cytogenetics, School of Bioengineering, Xuzhou University of Technology, Xuzhou, China
| | - Cui Zhang
- Laboratory of Molecular Cytogenetics, School of Bioengineering, Xuzhou University of Technology, Xuzhou, China
| | - Yanan Wang
- Laboratory of Molecular Cytogenetics, School of Bioengineering, Xuzhou University of Technology, Xuzhou, China
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34
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Gilmartin AG, Groy A, Gore ER, Atkins C, Long ER, Montoute MN, Wu Z, Halsey W, McNulty DE, Ennulat D, Rueda L, Pappalardi MB, Kruger RG, McCabe MT, Raoof A, Butlin R, Stowell A, Cockerill M, Waddell I, Ogilvie D, Luengo J, Jordan A, Benowitz AB. In vitro and in vivo induction of fetal hemoglobin with a reversible and selective DNMT1 inhibitor. Haematologica 2021; 106:1979-1987. [PMID: 32586904 PMCID: PMC8252945 DOI: 10.3324/haematol.2020.248658] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Pharmacological induction of fetal hemoglobin (HbF) expression is an effective therapeutic strategy for the management of beta-hemoglobinopathies such as sickle cell disease. DNA methyltransferase (DNMT) inhibitors 5-azacytidine (5-aza) and 5-aza-2'-deoxycytidine (decitabine) have been shown to induce fetal hemoglobin expression in both preclinical models and clinical studies, but are not currently approved for the management of hemoglobinopathies. We report here the discovery of a novel class of orally bioavailable DNMT1-selective inhibitors as exemplified by GSK3482364. This molecule potently inhibits the methyltransferase activity of DNMT1, but not DNMT family members DNMT3A or DNMT3B. In contrast with cytidine analog DNMT inhibitors, the DNMT1 inhibitory mechanism of GSK3482364 does not require DNA incorporation and is reversible. In cultured human erythroid progenitor cells (EPCs), GSK3482364 decreased overall DNA methylation resulting in de-repression of the gamma globin genes HBG1 and HBG2 and increased HbF expression. In a transgenic mouse model of sickle cell disease, orally administered GSK3482364 caused significant increases in both HbF levels and in the percentage HbF-expressing erythrocytes, with good overall tolerability. We conclude that in these preclinical models, selective, reversible inhibition of DNMT1 is sufficient for the induction of HbF, and is well-tolerated. We anticipate that GSK3482364 will be a useful tool molecule for the further study of selective DNMT1 inhibition both in vitro and in vivo.
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Affiliation(s)
| | - Arthur Groy
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | | | - Charity Atkins
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | - Edward R. Long
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | | | - Zining Wu
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | - Wendy Halsey
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | | | | | - Lourdes Rueda
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | | | - Ryan G. Kruger
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | | | - Ali Raoof
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
| | - Roger Butlin
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
| | - Alexandra Stowell
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
| | - Mark Cockerill
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
| | - Ian Waddell
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
| | - Donald Ogilvie
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
| | - Juan Luengo
- GlaxoSmithKline, Collegeville, Pennsylvania, PA, USA and
| | - Allan Jordan
- Drug Discovery Unit, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Manchester, UK
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35
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Abstract
Rare anemias (RA) are mostly hereditary disorders with low prevalence and a broad spectrum of clinical severity, affecting different stages of erythropoiesis or red blood cell components. RA often remains underdiagnosed or misdiagnosed, and treatment options have been limited to supportive care for many years. During the last decades, the elucidation of the molecular mechanisms underlying several RA paved the way for developing new treatments. Innovative treatments other than supportive care and allogeneic bone marrow transplantation are currently in clinical trials for β-thalassemias, sickle cell disease (SCD), and congenital hemolytic anemias. Recently, luspatercept, an activin receptor ligand trap targeting ineffective erythropoiesis, has been approved as the first pharmacological treatment for transfusion-dependent β-thalassemia. L-glutamine, voxelotor, and crizanlizumab are new drugs approved SCD, targeting different steps of the complex pathophysiological mechanism. Gene therapy represents an innovative and encouraging strategy currently under evaluation in several RA and recently approved for β-thalassemia. Moreover, the advent of gene-editing technologies represents an additional option, mainly focused on correcting the defective gene or editing the expression of genes that regulate fetal hemoglobin synthesis. In this review, we aim to update the status of innovative treatments and the ongoing trials and discuss RA treatments’ future directions. Interestingly, several molecules that showed promising results for treating one of these disorders are now under evaluation in the others. In the near future, the management of RA will probably consist of polypharmacotherapy tailored to patients’ characteristics.
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Myelodysplastic syndrome unrelated to lentiviral vector in a patient treated with gene therapy for sickle cell disease. Blood Adv 2021; 4:2058-2063. [PMID: 32396618 DOI: 10.1182/bloodadvances.2019001330] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
Key Points
Ability to accurately attribute adverse events post–gene therapy is required to describe the benefit-risk of these novel treatments. A SCD patient developed myelodysplastic syndrome post-LentiGlobin treatment; we show how insertional oncogenesis was excluded as the cause.
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Cheng AZ, Moraes SN, Shaban NM, Fanunza E, Bierle CJ, Southern PJ, Bresnahan WA, Rice SA, Harris RS. APOBECs and Herpesviruses. Viruses 2021; 13:v13030390. [PMID: 33671095 PMCID: PMC7998176 DOI: 10.3390/v13030390] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
The apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like (APOBEC) family of DNA cytosine deaminases provides a broad and overlapping defense against viral infections. Successful viral pathogens, by definition, have evolved strategies to escape restriction by the APOBEC enzymes of their hosts. HIV-1 and related retroviruses are thought to be the predominant natural substrates of APOBEC enzymes due to obligate single-stranded (ss)DNA replication intermediates, abundant evidence for cDNA strand C-to-U editing (genomic strand G-to-A hypermutation), and a potent APOBEC degradation mechanism. In contrast, much lower mutation rates are observed in double-stranded DNA herpesviruses and the evidence for APOBEC mutation has been less compelling. However, recent work has revealed that Epstein-Barr virus (EBV), Kaposi’s sarcoma-associated herpesvirus (KSHV), and herpes simplex virus-1 (HSV-1) are potential substrates for cellular APOBEC enzymes. To prevent APOBEC-mediated restriction these viruses have repurposed their ribonucleotide reductase (RNR) large subunits to directly bind, inhibit, and relocalize at least two distinct APOBEC enzymes—APOBEC3B and APOBEC3A. The importance of this interaction is evidenced by genetic inactivation of the EBV RNR (BORF2), which results in lower viral infectivity and higher levels of C/G-to-T/A hypermutation. This RNR-mediated mechanism therefore likely functions to protect lytic phase viral DNA replication intermediates from APOBEC-catalyzed DNA C-to-U deamination. The RNR-APOBEC interaction defines a new pathogen-host conflict that the virus must win in real-time for transmission and pathogenesis. However, partial losses over evolutionary time may also benefit the virus by providing mutational fuel for adaptation.
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Affiliation(s)
- Adam Z. Cheng
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA; (S.N.M.); (N.M.S.); (E.F.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Center for Genome Engineering, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (A.Z.C.); (R.S.H.)
| | - Sofia N. Moraes
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA; (S.N.M.); (N.M.S.); (E.F.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Center for Genome Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Nadine M. Shaban
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA; (S.N.M.); (N.M.S.); (E.F.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Center for Genome Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Elisa Fanunza
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA; (S.N.M.); (N.M.S.); (E.F.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Center for Genome Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Craig J. Bierle
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Peter J. Southern
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Wade A. Bresnahan
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Stephen A. Rice
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Reuben S. Harris
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA; (S.N.M.); (N.M.S.); (E.F.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; (C.J.B.); (P.J.S.); (W.A.B.); (S.A.R.)
- Center for Genome Engineering, University of Minnesota, Minneapolis, MN 55455, USA
- Howard Hughes Medical Institute, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (A.Z.C.); (R.S.H.)
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Meier ER, Creary SE, Heeney MM, Dong M, Appiah-Kubi AO, Nelson SC, Niss O, Piccone C, Quarmyne MO, Quinn CT, Saving KL, Scott JP, Talati R, Latham TS, Pfeiffer A, Shook LM, Vinks AA, Lane A, McGann PT. Hydroxyurea Optimization through Precision Study (HOPS): study protocol for a randomized, multicenter trial in children with sickle cell anemia. Trials 2020; 21:983. [PMID: 33246482 PMCID: PMC7691962 DOI: 10.1186/s13063-020-04912-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background Sickle cell disease (SCD) is a severe and devastating hematological disorder that affects over 100,000 persons in the USA and millions worldwide. Hydroxyurea is the primary disease-modifying therapy for the SCD, with proven benefits to reduce both short-term and long-term complications. Despite the well-described inter-patient variability in pharmacokinetics (PK), pharmacodynamics, and optimal dose, hydroxyurea is traditionally initiated at a weight-based dose with a subsequent conservative dose escalation strategy to avoid myelosuppression. Because the dose escalation process is time consuming and requires frequent laboratory checks, many providers default to a fixed dose, resulting in inadequate hydroxyurea exposure and suboptimal benefits for many patients. Results from a single-center trial of individualized, PK-guided dosing of hydroxyurea for children with SCD suggest that individualized dosing achieves the optimal dose more rapidly and provides superior clinical and laboratory benefits than traditional dosing strategies. However, it is not clear whether these results were due to individualized dosing, the young age that hydroxyurea treatment was initiated in the study, or both. The Hydroxyurea Optimization through Precision Study (HOPS) aims to validate the feasibility and benefits of this PK-guided dosing approach in a multi-center trial. Methods HOPS is a randomized, multicenter trial comparing standard vs. PK-guided dosing for children with SCD as they initiate hydroxyurea therapy. Participants (ages 6 months through 21 years), recruited from 11 pediatric sickle cell centers across the USA, are randomized to receive hydroxyurea either using a starting dose of 20 mg/kg/day (Standard Arm) or a PK-guided dose (Alternative Arm). PK data will be collected using a novel sparse microsampling approach requiring only 10 μL of blood collected at 3 time-points over 3 h. A protocol-guided strategy more aggressive protocols is then used to guide dose escalations and reductions in both arms following initiation of hydroxyurea. The primary endpoint is the mean %HbF after 6 months of hydroxyurea. Discussion HOPS will answer important questions about the clinical feasibility, benefits, and safety of PK-guided dosing of hydroxyurea for children with SCD with potential to change the treatment paradigm from a standard weight-based approach to one that safely and effectively optimize the laboratory and clinical response. Trial registration ClinicalTrials.gov NCT03789591. Registered on 28 December 2018.
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Affiliation(s)
- Emily R Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
| | - Susan E Creary
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Innovation in Pediatric Practice, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA
| | - Matthew M Heeney
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Min Dong
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abena O Appiah-Kubi
- Pediatric Hematology, Children's Hospitals and Clinics of Minnesota, Minneapolis and St. Paul, MN, USA
| | - Stephen C Nelson
- Division of Hematology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7015, Cincinnati, OH, 45229, USA
| | - Omar Niss
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Connie Piccone
- Case Western Reserve University School of Medicine, Department of Hematology and Oncology, University Hospitals Rainbow Babies and Children's, Cleveland, OH, USA
| | - Maa-Ohui Quarmyne
- Emory University School of Medicine & Sickle Cell Disease Program, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Charles T Quinn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | | | - John P Scott
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Teresa S Latham
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Amanda Pfeiffer
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Lisa M Shook
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam Lane
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Patrick T McGann
- University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
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Dong M, McGann PT. Changing the Clinical Paradigm of Hydroxyurea Treatment for Sickle Cell Anemia Through Precision Medicine. Clin Pharmacol Ther 2020; 109:73-81. [PMID: 32869281 DOI: 10.1002/cpt.2028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022]
Abstract
Sickle cell anemia (SCA) is a common and devastating inherited blood disorder, affecting millions of people across the world. Without treatment, SCA results in tremendous morbidity and early mortality. Hydroxyurea is the primary and most well-established pharmacologic therapy with proven benefits to ameliorate the clinical course of SCA, primarily due to its ability to increase the expression of fetal hemoglobin (HbF), which prevents sickling of red blood cells. The optimal induction of HbF depends upon selection and maintenance of the proper dose that maximizes benefits and minimizes toxicity. Due to the significant interpatient variability in hydroxyurea pharmacokinetics, pharmacodynamics, and dosing, most patients treated with hydroxyurea receive suboptimal doses and have only modest treatment responses. Recognizing this variability, using a precision medicine approach, we developed and prospectively evaluated an individualized dosing model for children with SCA, designed to optimize the hydroxyurea dose and clinical response. We utilize novel laboratory methods and a sparse sampling strategy requiring only 10 μL of blood collected 15 minutes, 60 minutes, and 180 minutes after a test dose. We use Bayesian adaptive control to estimate hydroxyurea exposure and to select an individual, optimal starting dose. This dosing model has resulted in HbF responses >30-40%, levels beyond what is achieved with traditional weight-based dosing and trial and error dose escalation. This hydroxyurea dosing strategy, if widely implemented, has the potential to change the treatment paradigm of hydroxyurea therapy and improve outcomes for the millions of patients with SCA across the world.
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Affiliation(s)
- Min Dong
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Patrick T McGann
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Thom H, Jansen J, Shafrin J, Zhao L, Joseph G, Cheng HY, Gupta S, Shah N. Crizanlizumab and comparators for adults with sickle cell disease: a systematic review and network meta-analysis. BMJ Open 2020; 10:e034147. [PMID: 32948541 PMCID: PMC7500297 DOI: 10.1136/bmjopen-2019-034147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Treatment options for preventing vaso-occlusive crises (VOC) among patients with sickle cell disease (SCD) are limited, especially if hydroxyurea treatment has failed or is contraindicated. A systematic literature review (SLR) and network meta-analysis (NMA) were conducted to evaluate the efficacy and safety of crizanlizumab for older adolescent and adult (≥16 years old) SCD patients. METHODS The SLR included randomised controlled trials (RCTs) and uncontrolled studies. Bayesian NMA of VOC, all-cause hospitalisation days and adverse events were conducted. RESULTS The SLR identified 51 studies and 9 RCTs on 14 treatments that met the NMA inclusion criteria. The NMA found that crizanlizumab 5.0 mg/kg was associated with a reduction in VOC (HR 0.55, 95% credible interval (0.43, 0.69); Bayesian probability of superiority >0.99), all-cause hospitalisation days (0.58 (0.50, 0.68); >0.99) and no evidence of difference on adverse events (0.91 (0.59, 1.43) 0.66) or serious adverse events (0.93 (0.47, 1.87); 0.59) compared with placebo. The HR for reduction in VOC for crizanlizumab relative to L-glutamine was (0.67 (0.50, 0.88); >0.99). These results were sensitive to assumptions regarding whether patient age is an effect modifier. CONCLUSIONS This NMA provides preliminary evidence comparing the efficacy of crizanlizumab with other treatments for VOC prevention.
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Affiliation(s)
- Howard Thom
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeroen Jansen
- Health Economics, PRECISIONheor, Los Angeles, California, USA
| | - Jason Shafrin
- Health Economics, PRECISIONheor, Los Angeles, California, USA
| | - Lauren Zhao
- Health Economics, PRECISIONheor, Los Angeles, California, USA
| | - George Joseph
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA
| | | | - Subhajit Gupta
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, North Carolina, USA
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Katayama K, Tsunemi T, Miyazaki K, Uoto K, Yoshioka R, Terashima H, Terakawa M, Yamashiro K, Haruyama M, Maeda H, Makino T. Design, synthesis, and optimization of a series of 2-azaspiro[3.3]heptane derivatives as orally bioavailable fetal hemoglobin inducers. Bioorg Med Chem Lett 2020; 30:127425. [PMID: 32717372 DOI: 10.1016/j.bmcl.2020.127425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
Pharmacological reactivation of the γ-globin gene for the production of fetal hemoglobin (HbF) is a promising approach for the management of β-thalassemia and sickle cell disease (SCD). We conducted a phenotypic screen in human erythroid progenitor cells to identify molecules that could induce HbF, which resulted in identification of the hit compound 1. Exploration of structure-activity relationships and optimization of ADME properties led to 2-azaspiro[3.3]heptane derivative 18, which is more rigid and has a unique structure. In vivo using cynomolgus monkeys, compound 18 induced a significant dose-dependent increase in globin switching, with developable properties. Moreover, compound 18 showed no genotoxic effects and was much safer than hydroxyurea. These findings could facilitate the development of effective new therapies for the treatment of β-hemoglobinopathies, including SCD.
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Affiliation(s)
- Katsushi Katayama
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
| | - Tomoyuki Tsunemi
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Kazuo Miyazaki
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Kouichi Uoto
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Ryosuke Yoshioka
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Hideki Terashima
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Maki Terakawa
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Kyoko Yamashiro
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Munetada Haruyama
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Hiroaki Maeda
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Tomohiro Makino
- Asubio Pharma Co. Ltd, 6-4-3 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
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Hankins JS, Shah N, DiMartino L, Brambilla D, Fernandez ME, Gibson RW, Gordeuk VR, Lottenberg R, Kutlar A, Melvin C, Simon J, Wun T, Treadwell M, Calhoun C, Baumann A, Potter MB, Klesges L, Bosworth H. Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization: Protocol for an Efficacy and Implementation Study. JMIR Res Protoc 2020; 9:e16319. [PMID: 32442144 PMCID: PMC7388044 DOI: 10.2196/16319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hydroxyurea prevents disease complications among patients with sickle cell disease (SCD). Although its efficacy has been endorsed by the National Health Lung and Blood Institute evidence-based guidelines, its adoption is low, both by patients with SCD and providers. Mobile health (mHealth) apps provide benefits in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescription among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. OBJECTIVE This study aims to increase hydroxyurea utilization through a combined two-level mHealth intervention for both patients with SCD and their providers with the goals of increasing adherence to hydroxyurea among patients and improve hydroxyurea prescribing behavior among providers. METHODS We will test the efficacy of 2 mHealth interventions to increase both patient and provider utilization and knowledge of hydroxyurea in 8 clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that address memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox), addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared with their adherence at baseline. As secondary objectives, we will (1) examine the change in health-related quality of life, acute disease complications, perceived health literacy, and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health and (2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the reach, effectiveness, adoption, implementation, and maintenance framework and qualitatively evaluate the implementation of both mHealth interventions. RESULTS The study is currently enrolling study participants. Recruitment is anticipated to be completed by mid-2021. CONCLUSIONS If this two-level intervention, that is, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future large-scale implementation-effectiveness study. TRIAL REGISTRATION ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16319.
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Affiliation(s)
- Jane S Hankins
- St. Jude Childrens Research Hospital, Memphis, TN, United States
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, United States
| | - Lisa DiMartino
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Donald Brambilla
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Robert W Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Victor R Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Richard Lottenberg
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainsville, FL, United States
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jena Simon
- Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - Ted Wun
- Division of Hematology Oncology, UC Davis School of Medicine, Davis, CA, United States
| | - Marsha Treadwell
- University of California San Francisco Benioff Children Hospital Oakland, Oakland, CA, United States
| | - Cecelia Calhoun
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Ana Baumann
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Michael B Potter
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Lisa Klesges
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Hayden Bosworth
- Department of Medicine, Duke University, Durham, NC, United States
| | -
- Bethesda, MA, United States
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Costa CPS, Thomaz ÉBAF, Ribeiro CCC, Souza SDFC. Biological factors associating pulp necrosis and sickle cell anemia. Oral Dis 2020; 26:1558-1565. [DOI: 10.1111/odi.13415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/12/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
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44
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Monfort JB, Senet P. Leg Ulcers in Sickle-Cell Disease: Treatment Update. Adv Wound Care (New Rochelle) 2020; 9:348-356. [PMID: 32286203 DOI: 10.1089/wound.2018.0918] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Significance: Sickle-cell leg ulcers (SCLUs) are a severe, chronic, and recurrent complication of sickle-cell disease (SCD). There are no official recommendations for treatment. Recent Advances: Only a few studies with a high level of evidence have been conducted to evaluate treatment of SCLUs. However, several studies have been conducted with a high level of evidence to evaluate the efficacy of treatments in venous leg ulcers, and SCLUs could benefit from these treatments, especially when a venous incompetence or an edema is associated. Pathophysiology of SCLUs includes a vasculopathy related to chronic hemolysis and an endothelial dysfunction, which could be therapeutic approaches to SCLU treatment. Critical Issues: Therapeutic approaches to SCLUs can target SCD on the one hand and skin healing and associated aggravating factors on the other. A review of the literature found only case series and six randomized controlled trials; some offered encouraging results, but most had serious biases. Clinical trials specifically targeting SCLUs are difficult to realize because of the small number of affected patients, in comparison with patients with leg ulcers from other causes. Future Direction: Treating SCLUs remains a challenge. Data in the literature are currently insufficient to offer clear treatment guidelines because of several biases in controlled studies. New studies are under way to assess the efficacy of topical treatments and describe the microbiome of SCLUs. Prevention of SCLU recurrence should be assessed in future clinical trials because the high risk of recurrence is an unsolved critical issue.
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Affiliation(s)
| | - Patricia Senet
- Department of Dermatology, Tenon Hospital, Paris, France
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Kayle M, Valle J, Paulukonis S, Holl JL, Tanabe P, French DD, Garg R, Liem RI, Badawy SM, Treadwell MJ. Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28152. [PMID: 32147964 PMCID: PMC7096276 DOI: 10.1002/pbc.28152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE Sickle cell disease (SCD) is associated with high acute healthcare utilization. The purpose of this study was to examine whether Medicaid expansion in California increased Medicaid enrollment, increased hydroxyurea prescriptions filled, and decreased acute healthcare utilization in SCD. METHODS Individuals with SCD (≤65 years and enrolled in Medicaid for ≥6 total calendar months any year between 2011 and 2016) were identified in a multisource database maintained by the California Sickle Cell Data Collection Program. We describe trends and changes in Medicaid enrollment, hydroxyurea prescriptions filled, and emergency department (ED) visits and hospital admissions before (2011-2013) and after (2014-2016) Medicaid expansion in California. RESULTS The cohort included 3635 individuals. Enrollment was highest in 2014 and lowest in 2016 with a 2.8% annual decease postexpansion. Although <20% of the cohort had a hydroxyurea prescription filled, the percentage increased by 5.2% annually after 2014. The ED visit rate was highest in 2014 and decreased slightly in 2016, decreasing by 1.1% annually postexpansion. Hospital admission rates were similar during the pre- and postexpansion periods. Young adults and adults had higher ED and hospital admission rates than children and adolescents. CONCLUSIONS Medicaid expansion does not appear to have improved enrollment or acute healthcare utilization among individuals with SCD in California. Future studies should explore whether individuals with SCD transitioned to other insurance plans or became uninsured postexpansion, the underlying reasons for low hydroxyurea utilization, and the lack of effect on hospital admissions despite a modest effect on ED visits.
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Affiliation(s)
| | - Jhaqueline Valle
- Sickle Cell Data Collection Program, Tracking California/ Public Health Institute, Richmond, California
| | - Susan Paulukonis
- Sickle Cell Data Collection Program, Tracking California/ Public Health Institute, Richmond, California
| | - Jane L. Holl
- Biological Sciences Division, University of Chicago, Chicago, IL
| | | | - Dustin D. French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Veterans Affairs Health Services Research and Development Service, Chicago, Illinois USA
| | - Ravi Garg
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
| | - Robert I. Liem
- 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
| | - Sherif M. 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
| | - Marsha J. Treadwell
- University of California San Francisco Benioff Children’s Hospital, Oakland, CA
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Soutou B, Senet P, Lionnet F, Habibi A, Aractingi S. Sickle cell disease induces resistance to cutaneous carcinogenesis. Orphanet J Rare Dis 2020; 15:66. [PMID: 32143660 PMCID: PMC7060573 DOI: 10.1186/s13023-020-1341-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background While skin carcinomas are reported in chronic ulcers and in patients treated with hydroxyurea (HU) for myeloproliferative neoplasms, no skin carcinoma has been reported in patients with sickle cell disease (SCD), presenting chronic skin ulcers or treated with HU. The objective was to estimate the risk of cutaneous malignant transformation in SCD patients with prolonged leg ulcers or under HU therapy. Results In this cross-sectional study, the cohort consisted of 1543 patients. In the first series, 29 patients presented a total of 53 ulcers lasting more than two years. The median age was 35 ± 8.4 years old. The median duration for a single ulcer was 9.2 ± 7 years. None of the examined ulcers showed any suspicious area of malignant transformation. In the second series, 187 patients treated with HU for more than two years were identified. The median age was 31.3 ± 9.9 years old. The median duration of treatment with HU was 6 ± 3.2 years. No skin carcinoma or actinic keratosis was recorded. Conclusions This study showed that skin carcinogenesis did not occur in our series of SCD patients exposed to transforming events such as long term HU treatment or prolonged leg ulcers.
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Affiliation(s)
- Boutros Soutou
- Faculté de médecine, Université Saint-Joseph, Beirut, 16-6830, Lebanon.
| | - Patricia Senet
- Department of Dermatology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - François Lionnet
- Department of Internal Medicine, Center for sickle cell disease, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anoosha Habibi
- Centre de référence des syndromes drépanocytaires majeurs, Unité des Maladies génétiques du globule rouge, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Sélim Aractingi
- Faculté de médecine Paris 5 Descartes. Service de Dermatologie, Hôpital Cochin Tarnier, Paris. Equipe Cellules souches foetales, Inserm UMR S 938, Paris, France
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Phenotypic-screening generates active novel fetal globin-inducers that downregulate Bcl11a in a monkey model. Biochem Pharmacol 2019; 171:113717. [PMID: 31751536 DOI: 10.1016/j.bcp.2019.113717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/13/2019] [Indexed: 01/02/2023]
Abstract
Heritable disorders associated with hemoglobin production are the most common monogenic disorders. These are mainly represented by disorders such as β-thalassemia and sickle cell disease. Induction of fetal hemoglobin (HbF) has been known to ameliorate the clinical severity of these β hemoglobinopathies. A high throughput phenotypic screening was used in this study to isolate novel compounds that may enhance the expression of γ-globin, the component of HbF, in human erythroid cell lines and primary erythroid progenitors derived from human CD34+ cells. The effect of lead compounds on epigenetic enzymes and key transcriptional factors was evaluated to identify their mode of action. One hit compound was further evaluated in vivo using monkey models. Among the ~18,000 compounds screened, 18 compounds were selected and tested to determine their ability to induce HbF in human erythroid cell lines and primary erythroid cells. One of these compounds, a 3-phenyl-isoxazole derivative, could potentially induce HbF in monkey bone marrow cells when administered orally. The compound downregulated negative transcriptional regulators of HbF, Bcl11a and LRF without inhibiting the known epigenetic enzymes. These studies demonstrated the advantages associated with phenotype-screening and identified novel fetal globin inducers that may be useful for treating hemoglobinopathies.
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Regan S, Yang X, Finnberg NK, El-Deiry WS, Pu JJ. Occurrence of acute myeloid leukemia in hydroxyurea-treated sickle cell disease patient. Cancer Biol Ther 2019; 20:1389-1397. [PMID: 31423878 DOI: 10.1080/15384047.2019.1647055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Hydroxyurea (HU) has been widely used in sickle cell disease. Its potential long-term risk for carcinogenesis or leukemogenic risk remains undefined. Here, we report a 26 y old African-American female with Sickle Cell Disease (SCD) who developed refractory/relapsed acute myeloid leukemia (AML) 6 months after 26 months of HU use. That patient's cytogenetics and molecular genetics analyses demonstrated a complex mutation profile with 5q deletion, trisomy 8, and P53 deletion (deletion of 17p13.1). P53 gene sequence studies revealed a multitude of somatic mutations that most suggest a treatment-related etiology. The above-mentioned data indicates that the patient may have developed acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) as a direct result of HU exposure.
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Affiliation(s)
- Samuel Regan
- Department of Medicine, College of Medicine, SUNY Upstate Medical University , Syracuse , New York , USA
| | - Xuebin Yang
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
| | | | - Wafik S El-Deiry
- Department of Pathology, Warren Alpert Medical School, Brown University , Providence , Rhode Island , USA
| | - Jeffrey J Pu
- Department of Medicine, College of Medicine, SUNY Upstate Medical University , Syracuse , New York , USA.,Upstate Cancer Center, Departments of Medicine, Pathology, and Pharmacology, SUNY Upstate Medical University , Syracuse , New York , USA.,Syracuse VA Medical Center, SUNY Upstate Medical University , Syracuse , New York , USA
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Soya E, Makowski C, Blaise S. Leg ulcer induced by hydroxycarbamide in sickle cell disease: What is the therapeutic impact? Int Wound J 2019; 16:897-902. [PMID: 30916480 PMCID: PMC7949276 DOI: 10.1111/iwj.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/28/2019] [Indexed: 11/27/2022] Open
Abstract
Major sickle cell disease syndrome (SCD) is a set of potentially serious and disabling constitutional haemoglobin pathologies characterised by chronic haemolysis and vaso-occlusion phenomena. If expression takes the form of acute vaso-occlusive crisis, SCD is currently considered to be a chronic systemic pathology, primarily associated with vasculopathy and ischaemia-reperfusion phenomena. The haemolytic aspect of the disease may be associated with endothelial dysfunctional complications, including leg ulcers, which are a classic spontaneous complication of major SCD. Their frequency, all aetiologies combined, varies considerably according to the series under consideration. Hydroxycarbamide has become the standard treatment for some SCD phenotypes, but has classically been described as one of the causes of leg ulcer. This causality is widely debated and is still difficult to establish because it is a specific complication of the disease. Comorbidity factors (eg, iron deficiency) are also often implicated as causal or aggravating factors so research into all the potential aetiologies of leg ulcers in a sickle cell patient must be exhaustive. We discuss the aetiologies of a leg ulcer in a patient treated by hydrocarbamide for major SCD. The imputation of the drug was established, followed by a marrow allograft in this patient.
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Affiliation(s)
- Esaie Soya
- Department of Vascular MedicineGrenoble University HospitalGrenobleFrance
| | | | - Sophie Blaise
- Department of Vascular MedicineGrenoble University HospitalGrenobleFrance
- UMR 1042–HP2INSERM and University Grenoble‐AlpesGrenobleFrance
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Appleby N, Angelov D. Clinical and laboratory assessment of a patient with thrombocytosis. Br J Hosp Med (Lond) 2019; 78:558-564. [PMID: 29019736 DOI: 10.12968/hmed.2017.78.10.558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Elevated platelet counts are frequently encountered in hospital medicine and arise from both physiological and pathological mechanisms. Thrombocytosis may be secondary, reflecting an inflammatory state, iron deficiency, recent surgery or point towards an underlying neoplasm. Thrombocytosis may be the presenting sign of solid tumours and haematological conditions. The discovery of the activating mutations affecting thrombopoiesis led to greater understanding of the pathobiology of essential thrombocythaemia and other myeloproliferative neoplasms. The investigation of suspected primary thrombocytosis has evolved to include testing for these disease-associated mutations. Therapy for patients with essential thrombocythaemia aims to reduce their risk of thrombotic complications by addressing cardiovascular risk factors, and using antiplatelet agents and, in selected patients, cytoreductive therapy. This article provides a logical approach to distinguishing reactive or secondary thrombocytosis from thrombocytosis associated with an underlying myeloproliferative neoplasm and gives an overview of the management of essential thrombocythaemia.
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Affiliation(s)
- Niamh Appleby
- Molecular Haematology Fellow, Molecular Haematology Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU
| | - Daniel Angelov
- Core Medical Trainee, Department of Haematology, Mater Misercordiae University Hospital, Dublin
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