A multicenter randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children

Abstract

• Intravenous magnesium did not shorten length of stay for pain crisis in children with sickle cell anemia.• Collaboration between pediatric emergency medicine and hematology allowed for successful enrollment in a sickle cell acute management trial.Magnesium, a vasodilator, anti-inflammatory, and pain reliever, could alter the pathophysiology of sickle cell pain crises. We hypothesized that intravenous magnesium would shorten length of stay, decrease opioid use, and improve health-related quality of life (HRQL) for pediatric patients hospitalized with sickle cell pain crises. The Magnesium for Children in Crisis (MAGiC) study was a randomized, double-blind, placebo-controlled trial of intravenous magnesium vs normal saline placebo conducted at 8 sites within the Pediatric Emergency Care Applied Research Network (PECARN). Children 4 to 21 years old with hemoglobin SS or Sb 0 thalassemia requiring hospitalization for pain were eligible. Children received 40 mg/kg of magnesium or placebo every 8 hours for up to 6 doses plus standard therapy. The primary outcome was length of stay in hours from the time of first study drug infusion, compared using a Van Elteren test. Secondary outcomes included opioid use and HRQL. Of 208 children enrolled, 204 received the study drug (101 magnesium, 103 placebo). Between-group demographics and prerandomization treatment were similar. The median interquartile range (IQR) length of stay was 56.0 (27.0-109.0) hours for magnesium vs 47.0 (24.0-99.0) hours for placebo (P 5 .24). Magnesium patients received 1.46 mg/kg morphine equivalents vs 1.28 mg/kg for placebo (P 5 .12). Changes in HRQL before discharge and 1 week after discharge were similar (P > .05 for all comparisons). The addition of intravenous magnesium did not shorten length of stay, reduce opioid use, or improve quality of life in children hospitalized for sickle cell pain crisis. This trial was registered at www.

A significant proportion of children of African descent with HbSβ0 thalassaemia are inaccurately diagnosed based on phenotypic analyses alone

“…A significant proportion of children of African descent with HbSb 0 thalassaemia are inaccurately diagnosed based on phenotypic analyses alone Two sickle cell disease (SCD) phenotypes, HbSS and HbSb 0 thalassaemia, are believed to be so similar in disease severity that all major paediatric National Institute of Health randomized controlled trials include both (Wang et al, 2011;DeBaun et al, 2014;Brousseau et al, 2015). However, data from our group and others suggest the two diagnoses are associated with different clinical courses (Serjeant et al, 1979;Zago et al, 1980), highlighting the importance of accurately distinguishing the two.…”

Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

“…Although there is no specific research on MgSO 4 applied to the anesthetic management of this pathology, recent clinical trials have assessed hospital stay and its analgesic use in children hospitalized for vaso-occlusive crisis and treated with MgSO 4 (40-100 mgÁkg À1 every 8 h). Current results make no significant difference to the standard treatment, being necessary further studies in the clinical setting, especially in the perioperative (65)(66)(67).…”

The trials and hopes for drug development in sickle cell disease

“…Magnesium has been shown to decrease potassium and water loss by blocking the potassium‐chloride co‐transport channel in RBCs (Bunn, ). In a recently presented multicentre, double‐blind, placebo‐controlled study of patients with HbSS or HbSβ 0 thalassaemia, treatment with intravenous magnesium did not shorten the length of stay, lessen opioid use or improve the quality of life in children who required inpatient hospitalization after failing emergency department management for pain (Brousseau et al , ).…”