Understanding the Perception of Hydroxyurea in Sickle Cell Disease Treatment

Hydroxyurea has been on the market for decades and yet it's underutilized as a treatment for sickle cell disease.

In this study, the causality of the underuse of hydroxyurea (HU) was explained to be bidirectional between patient and healthcare provider. Although it’s an effective, long-established disease-modifying agent for patients with sickle cell disease, it’s an underutilized treatment.

Mortadah Alsalman, Department of Medicine, College of Medicine, King Faisal University, and a team of investigators evaluated the attitudes and awareness toward hydroxyurea in adult patients with sickle cell disease.

According to investigators, it’s essential to educate both healthcare providers as well as patients with sickle cell disease about the role of hydroxyurea in modifying disease severity, resolving adverse events, and achieving full benefits of the treatment.

The Results

Investigators found a significant relationship between awareness of hydroxyurea and education level. A significant relationship was also shown between level of awareness and gender of patients, but not with age.

Of the 107 patients that investigators evaluated for attitude and awareness of hydroxyurea, it was known to 67.3% (72). Treatment with hydroxyurea was initiated in 63% (46) of patients and of these, 50% (23) discontinued hydroxyurea. The main reasons for discontinuation were pregnancy preparation and the development of adverse events.

As for the patients who had no awareness of hydroxyurea, 37.1% (13) were admitted to the intensive care unit with acute chest syndrome, 82.8% (29) needed a blood transfusion, and 34.2% (12) of patients experienced frequent hospitalizations.

There was a significant relationship between hydroxyurea treatment and the frequency of blood transfusion and hospitalization but the relationship was not significant with the admission to the intensive care unit.

The Motivation

“Hydroxyurea plays an essential role in the complex pathophysiology alteration of sickle-cell disease,” investigators wrote, “which translates clinically into the enhanced quality of life and increased survival.”

Investigators wanted to examine the attitude and awareness level toward hydroxyurea, as well as the consequences of underutilization, in patients with sickle cell disease. One of the countries with the highest prevalence of sickle cell disease is Saudi Arabia.

Studies have indicated that hydroxyurea is underutilized because of different beliefs and attitudes, even though it’s been approved as a modifying agent for sickle cell disease for decades. According to investigators there’s a proportion of patients with sickle cell disease that are almost entirely unaware of the treatment.

The Study

The cross-sectional study was conducted in Saudi Arabia’s eastern province because sickle cell disease is more common in this region than others. Patients with sickle cell disease were interviewed by a trained investigator for about 10-15 minutes.

In addition to acquiring information about their attitude and awareness of hydroxyurea, investigators also covered age, gender, education level, and clinical data such as comorbidities, frequency of hospitalization, blood transfusion, previous surgeries, and intensive care unit hospitalization.

Hospitalization was considered frequent if it occurred more than twice within a year in the previous 2 years. Blood transfusion was considered significant if it happened more than 5 times in a patient’s life.

“Our study showed that despite hydroxyurea being in the market for several decades, around one-third of participants are unaware of it rather than having a barrier to take it, as previously reported,” investigators wrote.

The study, "Hydroxyurea Usage Awareness Among Patients with Sickle-Cell Disease in Saudi Arabia", was published in Health Science Reports.