Secondary stroke prevention in kids with sickle cell anemia: low-dose hydroxyurea effective option

With a targeted minimum follow-up of 3.0 years, the median participant follow-up was 1.6 years (interquartile range: 1.0–2.3). The primary end measure's incidence rates showed no clinically significant difference; hence the experiment was terminated early.

Key findings of the trial:

• In the low- and moderate-dose groups, there were a combined 6 recurrent strokes and 2 fatalities against 5 recurrent strokes and 3 deaths.
• In the low- and moderate-dose hydroxyurea therapy groups, the incidence rate ratio (IRR) of the primary outcome measure of stroke or death was 0.98 (95% CI 0.32 - 3.00), P=0.97.
• Recurrent stroke incidence rates in the low- and moderate-dose groups were 7.1 and 6.0 per 100 person-years, respectively; IRR= 1.18 (95% CI: 0.30-4.88); P=0.74.
• The median percent of medications returned as an indicator of adherence to the oral hydroxyurea medication was 3.0% in the low-dose group and 2.6% in the moderate-dose group, respectively.
• No participant's hydroxyurea treatment was discontinued due to myelosuppression.

They noted that there was a median interval of 0.8 years between the initial stroke and death.

The researchers came to the conclusion that hydroxyurea in low-resource settings is effective at preventing subsequent strokes at both low- and moderate doses.

REFERENCE

Shehu Abdullahi, Surayya Murtala Sunusi, Mohammed Sani Abba, Saifuddeen Sani, Hauwau Aminu Inuwa, Safiya Gambo, Awwal Gambo, Bilya Sani Musa, Brittany V. Covert Greene, Adetola Kassim, Mark Rodeghier, Nafiu Hussaini, Mariana Ciobanu, Muktar Hassan Aliyu, Lori C Jordan, Michael R DeBaun; Hydroxyurea for Secondary Stroke Prevention in Children with Sickle Cell Anemia in Nigeria:a Randomized Controlled Trial. Blood 2022; blood.2022016620. doi: https://doi.org/10.1182/blood.2022016620