Effective use of hydroxyurea for sickle cell anemia in low-resource countries

Abstract

Purpose of review Over the past several decades, hydroxyurea has emerged as a well tolerated and potent disease-modifying therapy for children and adults with sickle cell anemia (SCA). Strong, evidence-based recommendations from the National Institutes of Health, American Society of Hematology, and British Society of Haematology document that hydroxyurea is now standard of care treatment for SCA. In low-resource settings, however, hydroxyurea is rarely utilized due to lack of availability, inadequate treatment guidance, and excessive costs. Recent findings Research trials conducted within the Caribbean and sub-Saharan Africa confirm the efficacy of hydroxyurea as a well tolerated, feasible, and beneficial treatment in low-resource countries. Hydroxyurea is therefore vital to reaching the targets for control of SCA outlined by the WHO. To maximize its utilization toward real-world effectiveness, specific attention must be given to healthcare provider education and training, public and institutional awareness, and medication access and affordability. Summary Efforts to introduce hydroxyurea effectively into low-resource countries should urgently address the lack of treatment guidelines, gaps in knowledge and clinical infrastructure, and medication inaccessibility. Partnerships among governmental, academic, pharmaceutical, and charitable organizations must tackle these barriers so that all individuals living with SCA worldwide can benefit from hydroxyurea.

Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018

“…For this, it becomes necessary to understand that the effective use of HU, mainly in countries with few financial resources, results from aspects such as guidelines, training, adequate infrastructure, and accessibility to drug treatment. 49 The lethality rate found was similar to that observed by another Brazilian study, 50 and the higher specific mortality observed among women is also not different from already conducted studies; 51,52 such as the death age range of 30 to 35 years old, 50 where it is possible to evidence that the survival of the patients with SCA is considered lower than that of the Brazilian population. 50 Although there is no difference in mortality between men and women in worldwide surveys, higher mortality among women may be associated with complications related to pregnancy and the puerperium since pregnancy can be considered an important risk factor for death among women.…”

Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos, North-Central Nigeria

“…This is in synergy with the findings from recent studies which acknowledged the lack of treatment guidelines as a barrier to the use of hydroxyurea, especially in low-resource countries. 25 , 26 The development of clinical guidelines could help to standardize practice, boost the confidence and enhance the expertise of the physicians. It is worth noting that there's an on-going effort by the Sickle Cell Disease Stroke Prevention in Nigeria (SPIN) trial towards establishing local clinical guidelines for hydroxyurea use, especially for stroke prevention.…”

Dietary alpha‐linolenic acid reduces platelet activation and collagen‐mediated cell adhesion in sickle cell disease mice

“…Despite affecting millions of people worldwide and having an enormous economic burden, only few therapies for SCD are available, 26,49 the first approved being hydroxyurea. However, especially in the sub-Saharan and Caribbean regions, which have the highest prevalence of the disease, patients have no access to effective remedies.…”