CHILDREN with sickle cell anaemia (SCA) are at risk of stroke, pain crises, and even early death. Hydroxyurea has been established as the primary disease-modifying therapy for individuals with SCA, but remains underused among children with the disease.
Sarah Reeves, University of Michigan School of Public Health, Ann Arbor, USA, commented: “Despite changes in clinical guidelines to recommend hydroxyurea for all children with SCA starting in 2014, the majority of youths did not receive this disease-modifying therapy”. Reeves went on: “Although disappointing, this was not surprising. Our previous research showed that children with SCA do not receive other essential, recommended preventive services at high rates. Specifically, less than one in 10 receive enough antibiotic prophylaxis in the year to protect against infection, and less than half receive screening for strokes.”
Reeves and colleagues conducted a cross-sectional study utilising data collected between 2010–2018 from Medicaid programmes in Michigan and New York states, USA. Overall, 4,302 youths with SCA aged between 1–17 were included in the study, resulting in a total of 12,565 person-years of data. Hydroxyurea use was calculated using the mean annual counts of days’ supply of filled hydroxyurea prescriptions.
The mean annual days’ supply was 47.2 days per child, and 97.4 days per child in Michigan and New York, respectively. Furthermore, data from Michigan identified an increase in the odds of having ‘non-zero’ days’ supply of the agent following release of the updated guidelines (odds ratio: 1.52; 95% confidence interval: 1.07–2.14) published by the National Heart, Lung, and Blood Institute (NHLBI) who recommend for children aged 9 months and older, regardless of disease severity. However, this trend was not observed in New York.
Overall, these findings indicate a need for increased hydroxyurea uptake and additional interventions among children with SCA. However, widescale implementation trials are yet to be conducted to assess improved uptake. Therefore, it “is important that family and patient voices and perspectives be integrated into any intervention. This is particularly true given the wider systemic issues often facing individuals living with SCD, such as structural and institutional racism,” commented Reeves.