Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman

Abstract

Objectives Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients’ adherence to medication, discontinuation of use, and safety of HU in patients with SCD. Methods This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. Results Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age ( p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence ( p = 0.015). Conclusions Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.

Barriers to hydroxyurea use from the perspectives of providers, individuals with sickle cell disease, and families: Report from a U.S. regional collaborative

“…We adopted the intentional and unintentional medication nonadherence framework in the present study to enhance understanding of unique barriers to hydroxyurea for the SCD population (Hodges et al, 2020). We demonstrated that, even for patients on hydroxyurea, challenges to taking the medicine at the right time and forgetting were crucial unintentional barriers to adherence, consistent with other reports (Badawy et al, 2017;Jose et al, 2019;Hodges et al, 2020). Forgetfulness may be associated with neurocognitive deficits, including memory impairment and diminished executive functioning, that may occur in SCD (Feliu et al, 2011;Prussien et al, 2019;Martin et al, 2020).…”

Extensive porto-splenic venous thrombosis postsplenectomy in a sickle cell disease: a rare complication

“…There are around 3000 cases of SCD in Oman and around 10% of the Omani population are carriers for the sickle cell gene 1. There is no known cure for the disease since it is a genetic disorder except bone marrow transplant 2 3. There are recent studies of gene therapy to cure SCD, those trials are still being investigated 3…”

Barriers and Facilitators of Use of Hydroxyurea among Children with Sickle Cell Disease: Experiences of Stakeholders in Tanzania

“…Obtaining a refill from the pharmacy and coming for follow-up have been reported as patient-related barriers. Furthermore, a study performed by Jose et al (2019) reported that patients' misperception about HU side effects, poor knowledge on the benefit of HU, and poor health literacy could be the reason for the observed HU underutilization [10].…”