Is Hydroxyurea Underused in Sickle Cell Anemia?

David Green, MD, PhD reviewing Stettler N et al. JAMA 2015 Apr 28.

Analysis of a nationwide claims database shows that this safe and effective drug is vastly underused by adult sickle cell patients with pain crisis.

Hydroxyurea has been shown to decrease the frequency of pain crises, hospitalizations, and blood transfusions in patients with sickle cell anemia (SCA). However, there is concern that the drug is underutilized.

To determine the proportion of adults with SCA and pain crises who receive hydroxyurea, investigators interrogated the nationwide OptumNormative Health Informatics database of commercial health and pharmacy claims.

In an enrolled population of more than 26 million individuals, 2086 adults had probable SCA. Of the 677 patients who had ≥3 pain crises within the previous 12 months, only 15.1% filled one or more hydroxyurea prescriptions within 3 months of their third pain crisis. This percentage increased to 18.2 within 6 months and 22.7 after 12 months of continued enrollment following the third episode (P=0.002 for the trend).

CITATION(S):

Stettler N et al. Proportion of adults with sickle cell anemia and pain crises receiving hydroxyurea. JAMA 2015 Apr 28; 313:1671.