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

Abstract

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.

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

“…[31][32][33][34][35] Six included records involved 3 distinct studies, all published twice as separate, full-paper publications. [36][37][38][39][40][41] The remaining total of 36 unique studies was included in this review, covering 26 different prophylactic interventions.…”

“…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.…”

“…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.…”

“…[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.…”

“…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. 40,41 All 3 studies scored an unclear or high risk of bias for multiple items in the quality assessment.…”