Hydoxycarbamide and L-Carnitine Therapy in Sickle Cell Anemia
Study Details
Study Description
Brief Summary
The role of the combination therapy of hydroxyurea and L-Carnitine was studied in thalassemic patients. nevertheless its role in sickle cell anemia patients was not investigated
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
Sickle cell disease (SCD) is a common monogenic disorder affecting over 100,000 people in the United States alone, and millions more worldwide. This often devastating disease is characterized by red blood cell (RBC) sickling; chronic hemolytic anemia; episodic vaso-occlusion associated with severe pain and inflammation; acute and cumulative organ damage that manifests as stroke, acute chest syndrome, sickle lung disease, pulmonary hypertension nephropathy and end-stage renal disease; and other chronic morbidities.
Lives of patients with SCD are characterized by frequent episodes of severe pain (vaso-occlusive events or "crises"); acute organ dysfunction, including a pneumonia-like syndrome termed acute chest syndrome, and strokes starting in childhood; and progressive multi-organ damage. Not surprisingly, patients with SCD have very high health care utilization (over $1 billion/year in healthcare costs in the United States alone, and a median life-expectancy of only ~45-58 years, compared to the life expectancy of 78.2 years overall in the United States.
Although it is licensed in the United States for administration to sickle cell patients who have ≥ 3 crises a year in steady state, hydroxyurea (HU) remains unlicensed in most countries where it is regarded as an experimental drug In those areas, where HU is unlicensed for SCD, it is offered to patients who have ≥ 5 crises a year; or 3-4 crises a year with either neutrophil count ≥ 10 × 109/L or platelet count ≥ 500 × 109/L in steady state ; bearing in mind that the reference range for neutrophil count in black people is 1-3 × 109/L, and is 100-300 × 109/L for platelets .
Since high neutrophil count in steady state is a marker of severe SCD , these criteria usually identify individuals who have a clinical course sufficiently severe to ensure that the benefits of hydroxyurea therapy justify the potential risks. HU therapy is offered if the patient does not want to have (more) children, and is weighed against any severe impairment of liver or kidney function, or blood cytopenia. HU is unlicensed in most countries because the long-term adverse effects are unknown, not because the clinical efficacy is in doubt. In fact, after over 9 years of follow-up, HbSS subjects who received HU in the US placebo-controlled trial, had significantly less painful crises, acute chest syndrome, and mortality . Potential long-term toxic effects that reduce enthusiasm for HU include teratogenicity, carcinogenesis and, for young children, impaired cognitive development.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Hydra+L-Carnitine Hydroxycarbamide+ L-Carnitine+supportive treatment |
Drug: Hydroxycarbamide 500 Mg Oral Capsule+L-Carnitine
Combination therapy
Other Names:
|
| Active Comparator: Hydra only Hydroxycarbamide+ supportive treatment |
Drug: Hydroxycarbamide 500 Mg Oral Capsule
Single agent
Other Names:
|
| Active Comparator: L-Carnitine only L-Carnitine+ supportive treatment |
Drug: L-Carnitine, 250 Mg Oral Capsule
single agent
Other Names:
|
| No Intervention: Supportive measures Supportive only |
Outcome Measures
Primary Outcome Measures
- Hematological(HR) [2-3 months]
Change of hemoglobin
- Hematological response [2-3 months]
Change of hematocrit
Secondary Outcome Measures
- Frequency of painful episodes/ blood transfusions [1-year]
Change of frequency of painful episodes and blood transfusion
Other Outcome Measures
- Delayed effects [12-18 months]
effect on long term complications as cardiovascular and cerebrovascular ones
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients with sickle cell disease
-
Not welling for pregnancy in females or to father a baby in males
-
Frequent episodes
-
Non-compliance to transfusion
Exclusion Criteria:
-
<18 years
-
Hypersensitivity to hydroxycarbamide or L-Carnitine
-
Pregnancy
-
Other chronic infection or inflammation
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Safaa A A Khaled | Assiut | Egypt | 71515 |
Sponsors and Collaborators
- Assiut University
Investigators
- Study Director: Israa EM Ashry, Prof, Assiut University- Faculty of Medicine
Study Documents (Full-Text)
None provided.More Information
Publications
- Bunn HF. Pathogenesis and treatment of sickle cell disease. N Engl J Med. 1997 Sep 11;337(11):762-9. Review.
- Elmariah H, Garrett ME, De Castro LM, Jonassaint JC, Ataga KI, Eckman JR, Ashley-Koch AE, Telen MJ. Factors associated with survival in a contemporary adult sickle cell disease cohort. Am J Hematol. 2014 May;89(5):530-5. doi: 10.1002/ajh.23683. Epub 2014 Feb 21.
- Kauf TL, Coates TD, Huazhi L, Mody-Patel N, Hartzema AG. The cost of health care for children and adults with sickle cell disease. Am J Hematol. 2009 Jun;84(6):323-7. doi: 10.1002/ajh.21408.
- Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, Klug PP. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med. 1994 Jun 9;330(23):1639-44.
- Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 2010 Dec 11;376(9757):2018-31. doi: 10.1016/S0140-6736(10)61029-X. Epub 2010 Dec 3. Review.
- SKhaled2021