Hydroxyurea for Sickle Cell Anemia Linked to Improved Academic Performance

A new study suggests that hydroxyurea usage may improve academic performance in pediatric sickle cell patients.

“Although hydroxyurea is beneficial in prevention of [pain] episodes, since the drug is prescribed for a long duration, it is very important to analyze its effect on whole body including growth, development, systems, and scholastic performance,” the study investigators indicated.

The prospective analytic study was conducted by investigators at Mahatma Gandhi Memorial Medical College in India and included children aged 5-14 years with sickle cell anemia (SCA).

Children with the sickle cell trait, other hemoglobinopathies, or already on hydroxyurea were excluded from the study.

Hydroxyurea and Scholastic Performance

All enrolled patients (n = 73) were prescribed a fixed dose of 20 mg/kg/day and were followed at 2-month intervals for up to 6 months. Of the population, 54 completed the study, of which 51.8% were boys.

The investigators evaluated academic performance according to school attendance and examination performance. As such, these results were compared with the parameters from the previous year, prior to hydroxyurea usage.

A paired t-test and Fisher’s exact test were used to compare the effect of hydroxyurea therapy in this population.

Of note, the investigative team observed improvements in the children’s academic performance as well as no worsening grades or school attendance during the course of the study.

Improvements in grades were reported in 33.3% of patients.

More specifically, prior to the study period, 22.2% and 25.95% of students had A and B grades, respectively. After 6 months of therapy, the proportion of students with such grades increased to 37% and 29.6%, respectively (P = .001).

Even more, grades C and D decreased from 42.6% and 9.2%, respectively, to 27.8% and 5.6%, respectively.

There was also an increase in mean school attendance from 63.98% to 68.09%. However, the increase was not considered statistically significant (P = .68).

“Hydroxyurea therapy decreases frequency of recurrent hypoxia, anemia and silent or overt stroke, acute episodic painful crisis, and repeated hospitalization thereby reducing the number of sick days,” noted the investigators 

“This ultimately improves the scholastic performance, achievements, and overall well-being of the patient.”

A Previous Study: Neurocognitive Performance

Another study published this year found that hydroxyurea usage was associated with improved intellectual functioning and academic achievement following 1 year of treatments

This data was ascertained using fMRI, ASL, MRI, anatomical MRI, TCD, as well as neuropsychologic and hematologic evaluations in patients with a mean age of 12.4 years.

The investigators of that study thus noted increases in Full-Scale IQ scores (FSIQ), improvements in reading comprehension, and a significant decrease in TCD velocity. There were no significant changes in gray matter cerebral blood flow, blood oxygen level dependent signal from visual stimulation, or frequency of silent cerebral infarcts.

Nonetheless, additional and large-scale research is needed to fully understand the mechanisms involved between hydroxyurea use and cognitive improvement, as well as to confirm these associations. 

The study, “A study about effect of hydroxyurea on scholastic performance of children with sickle cell anemia,” was published online in Indian Journal of Child Health.