A Preliminary Report on Piracetam in Sickle Cell Anemia: A Double-Blind Crossover Clinical Trial and Effects on Erythrocyte Survival

Mikati, M. A.; Solh, Hassan Mohamed El; Deryan, Denise E.; Sahli, Itaf F.; Dabbous, Ibrahim

doi:10.5144/0256-4947.1983.233

Cited by 4 publications

(7 citation statements)

References 9 publications

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“…38,40,43,[46][47][48][49][51][52][53][54]57,60,62,63,[66][67][68][69][71][72][73][74] The other studies were either too small or methodologically inadequate to draw strong conclusions. 37,42,44,45,56,64 The amino acid L-glutamine seemed to be of great efficacy in patients with HbSS or HbSb 0 disease on the relevant outcomes of this review. 61 The pathophysiological rationale for its effect in SCD has not yet been extensively studied.…”

Section: Discussionmentioning

confidence: 99%

“…The first was an early crossover study in Lebanon (N 5 9) suggesting a reduction in the number of pain crises per patient per month in the piracetam group. 45 The second study (N 5 87), performed in Saudi Arabia, demonstrated a significant decrease in the mean number of painful crises and hospitalizations per year and in a composite nonvalidated severity index (Table 1; supplemental Table 3). 36,37 The third study was a crossover trial in Brazil (N 5 73) and did not show any benefit.…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

“…A majority of studies were limited to patients with the HbSS or HbSb 0 genotype (n 5 26). 37,38,42,44,45,[48][49][50][51][52][53][54][55][56][57][59][60][61]63,64,66,67,[69][70][71]74 A summary overview of the characteristics, risk of bias, and primary outcomes of the included studies is provided in Table 1. The complete results of our risk-of-bias assessment and a detailed overview of the primary and secondary outcomes of this review per study are provided in supplemental Tables 2 and 3, respectively.…”

Section: Selection Of Articlesmentioning

confidence: 99%

“…1968 and 2016, of which 15 trials were published before the year 2000 37,[42][43][44][45][46][47][48][49][50][51][52][53][54][55] and 8 in the last 5 years. [56][57][58][59][60][61][62][63] Three studies did not use a placebo intervention for their control group.…”

Section: Selection Of Articlesmentioning

confidence: 99%

“…[58][59][60]66,69,72,73 Fourteen studies scored a high risk of bias on at least 1 of the items of the quality assessment, in particular on incomplete outcome data (n 5 8) and blinding of participants (n 5 6) and personnel for intervention (n 5 6). 37,[43][44][45]48,49,51,54,56,63,64,70,71,74 Anticoagulation. A total of 7 studies assessed interventions targeting coagulation activation.…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

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Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review

et al. 2017

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Sickle-cell disease (SCD) is characterized by frequent and painful vaso-occlusive crises (VOCs).Various treatments have been evaluated over the years. However, a clear overview is lacking.The objective of this study was to systematically review all pharmacotherapeutical strategies in the prevention of VOCs beyond hydroxyurea. We performed a systematic literature search (MEDLINE, Embase, CENTRAL). Eligible studies were controlled clinical trials evaluating pharmacotherapeutical interventions targeting the reduction of VOCs in patients with SCD.Primary outcomes were the number or duration of SCD-related pain days, VOCs, or hospital admissions for VOCs. Secondary outcomes included time to first VOC or hospital admission for a VOC. A standardized data extraction sheet was used. The methodological quality of studies was assessed using Cochrane's risk-of-bias tool. A total of 36 studies were included in this review, covering 26 different prophylactic interventions. The most promising interventions for reducing the frequency of either VOCs or hospitalizations were the oral antioxidants L-glutamine and v-3 fatty acids and the IV antiadhesive agent crizanlizumab. Twenty-three studies did not show any beneficial effect of the intervention under investigation, and 6 studies were either too small or methodologically inadequate to draw conclusions. Because of the heterogeneity of interventions, no meta-analysis was performed. In conclusion, this review identified 3 promising pharmacotherapeutical strategies in the prevention of VOCs in SCD. Importantly, this study highlights the discrepancy between the significant burden of SCD worldwide and the low number of adequate trials performed. This review was

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Section: Discussionmentioning

confidence: 99%

Section: Quality Of the Included Studiesmentioning

confidence: 99%

Section: Selection Of Articlesmentioning

confidence: 99%

Section: Selection Of Articlesmentioning

confidence: 99%

Section: Quality Of the Included Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review

et al. 2017

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Piracetam: A Review of Pharmacological Properties and Clinical Uses

2005

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Piracetam, a derivative of the neurotransmitter ã-aminobutyric acid (GABA), has a variety of physiological effects that may result, at least in part, from the restoration of cell membrane fluidity. At a neuronal level, piracetam modulates neurotransmission in a range of transmitter systems (including cholinergic and glutamatergic), has neuroprotective and anticonvulsant properties, and improves neuroplasticity. At a vascular level, it appears to reduce erythrocyte adhesion to vascular endothelium, hinder vasospasm, and facilitate microcirculation. This diverse range of physiological effects is consistent with its use in a range of clinical indications. Its efficacy is documented in cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia, and sickle cell anemia. While high doses are sometimes necessary, piracetam is well tolerated.

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Piracetam Is Useful in the Treatment of Children with Sickle Cell Disease

El‐Hazmi¹,

Warsy

Al-Fawaz³

et al. 1996

Acta Haematol

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The management of children suffering from sickle cell disease [sickle cell anaemia (SCA) and sickle cell beta degree-thalassaemia (S beta degree-thal.)] has been the concern of all clinicians caring for these patients. Several agents have been tried for treatment, often limited by toxic side effects. Piracetam (2-oxo-l-pyrrolidine acetamide, Nootropyl), a cyclic derivative of gamma-amino butyrate, used for the treatment of psychosenescent syndromes with no known side effects, was considered as a possible therapeutic agent for sickle cell disease. Interest was focused on the use of piracetam when it was shown that it had an antisickling effect, both in vivo and in vitro. We initiated multicentre double-blind investigations in two groups of children suffering from sickle cell disease ranging in age from 3-6 to 6-12 years. The total number of patients included in the study were 87 (SCA = 79 and Hb S beta degree-thal. = 8) in 13 centres in 10 different regions of Saudi Arabia. Coded boxes of the drugs were received from the company (UCB) and were administered as intravenous infusion during crises and orally during the follow-up, for a period of up to 1 year. After decoding the code at the end of the study, the patients were grouped into those receiving placebo (n = 39), i.e. controls, or piracetam (n = 48), i.e. study cases. In terms of age, weight, height and severity index, number of blood transfusions received and number of hospitalization, both groups were statistically homogenous. Data analysis showed that the clinical severity of the disease, the number of crises, the extent of hospitalization and the blood transfusion requirements significantly decreased during piracetam treatment (p < 0.001), though no statistically significant changes occurred in the placebo group. However, in the levels of the haematological and biochemical parameters no significant changes were documented in both groups. In addition, the improvement in the clinical presentation of the disease continued even several months after discontinuation of the drug in the majority of the children, as judged from the low severity index value. Though our results point to the recommendation that piracetam can be used for the treatment of children suffering from sickle cell disease, both SCA and S beta degree-thal, it is advisable to conduct long-term and close follow-up treatment programmes using piracetam to establish its therapeutic value particularly in adults and to ascertain that there are no long-term toxic side effects.

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A Preliminary Report on Piracetam in Sickle Cell Anemia: A Double-Blind Crossover Clinical Trial and Effects on Erythrocyte Survival

Cited by 4 publications

References 9 publications

Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review

Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review

Piracetam: A Review of Pharmacological Properties and Clinical Uses

Piracetam Is Useful in the Treatment of Children with Sickle Cell Disease

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