Children living with sickle cell anaemia can be safely treated with hydroxyurea, a daily oral medication that reduces complications by boosting fetal haemoglobin. This finding comes from a large study conducted across four African sites: Angola, DR Congo, Kenya, and Uganda.
While hydroxyurea is a recommended treatment in high-income countries, caution has been exercised in low-income settings due to concerns it might reduce infection-fighting neutrophils. However, the study, part of the National Institutes of Health-funded REACH trial, found no increase in the incidence or severity of infections, including malaria, in children receiving the treatment.
Sickle cell anaemia, the most common severe inherited blood disease, affects approximately 550,000 children born annually, primarily in sub-Saharan Africa. It leads to complications like pain, vulnerability to infections, and chronic ill health. Bacterial and viral infections are common and can be life-threatening.
The research, published in The Lancet Haematology, involved 606 children and young adults treated with hydroxyurea. Patients received the drug for six months at a fixed dose, then escalated to the maximum tolerated dose. Follow-up occurred every two to three months since recruitment between 2014 and 2016.
The study revealed that the incidence of malarial and non-malarial infections actually decreased with increasing hydroxyurea dosage, with a 51% drop for malaria and 38% for non-malarial infections. This extended analysis, part of the REACH trial running for over 10 years, confirms hydroxyurea's safety and effectiveness in reducing sickle-related complications.
Professor Tom Williams from Imperial's Institute of Global Health Innovation, the study lead, stated: “In this huge study covering more than 5,000 patient years of follow-up we found no increase of illness or death from infections, even when hydroxyurea is used at the maximum tolerated dose.”
Senior author Professor Russell Ware of Cincinnati Children’s Hospital Medical Center added: “Over 10-years of treatment, the incidence and severity of infections did not increase, and in many cases, were decreased.”
The study authors recommend that children with sickle cell anaemia in low-resource settings should receive hydroxyurea treatment at the maximum tolerated dose, supporting its wider use as standard of care.
