- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00402480
Hydroxyurea to Prevent Stroke in Children With Sickle Cell Anemia and Elevated TCD Flow Velocity
Effects of Hydroxyurea on the Prevention of Primary Stroke in Children With Sickle Cell Anemia and Elevated Transcranial Doppler (TCD) Flow Velocity
Study Overview
Detailed Description
The purpose of this study is to assess prospectively the efficacy of hydroxyurea therapy in the setting of cerebrovascular disease, manifest as conditional or abnormal transcranial doppler ultrasonography (TCD) flow velocities, in children with sickle cell anemia (SCA). TCD is used to measure flow velocity in intracranial arteries as a marker of increased stroke risk in children with SCA. The primary objective of this protocol is to determine whether hydroxyurea reduces elevated TCD velocity.
The STOP (Stroke Prevention in Sickle Cell Anemia) trial, a multicenter, randomized, controlled trial for primary stroke demonstrated that monthly blood transfusions, when compared to observation alone, significantly reduced the risk of primary stroke for children with SCA whose TCD velocity exceeded 200 cm/sec. Despite the STOP trial's clear results, there are unresolved issues regarding TCD and stroke risk in children with SCA. First, the predictive value of an abnormal result is not compelling since less than a third of children with an abnormal TCD velocity and even fewer with conditional results will ever develop a clinical stroke. There is also discordance between TCD and MRI results. Only 40% of children with abnormal TCD velocity will have abnormalities on brain MRI (Wang, et al. J Pediatr Hematol/Oncol 2000;22(4):335-339, Pegelow, et al. Arch Neurol 2001;58:2017-2021). There are also well recognized risks of chronic blood transfusions, including iron overload and alloimmunization, and the necessary duration of transfusion protection for children with abnormal TCD velocity is unknown. Unfortunately, there are currently no therapeutic options besides blood transfusions for patients with SCA and an abnormal TCD velocity.
Erythrocyte transfusions and hydroxyurea have many similar beneficial effects in patients with SCA. Transfusions may prevent primary stroke by lowering the % HbS, by increasing the hematocrit, by improving red cell rheology, by decreasing red cell adhesion, and by lowering TCD velocity. Hydroxyurea leads to many of the same changes, thus in this protocol, we will examine whether hydroxyurea, like transfusions, can lower TCD velocity. In our patients with SCA who have been screened with TCD ultrasonography, we have observed that children who were screened while receiving hydroxyurea had lower TCD velocity measurements than those who were not on hydroxyurea. In a small number of patients with TCD velocity measurements before and after initiation of hydroxyurea for non-neurological reasons, the TCD velocity declined significantly after achieving full dose hydroxyurea therapy. The changes in TCD velocity were correlated with changes in hematocrit since hydroxyurea increases blood counts in patients with SCA. For each % increase in hematocrit, the TCD velocity increased by 6.3 cm/sec. This was similar to an abstract from the STOP trial, in which TCD flow velocity declined by 7.9 cm/sec for each increase in % hematocrit from transfusions.
Based on this preliminary data, we initiated this prospective, single-institution, pilot trial to determine whether hydroxyurea therapy lowers TCD flow velocity in children with sickle cell anemia.
Study Type
Enrollment
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27710
- Duke University Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Children with Sickle Cell Anemia
- Aged 3 to 18 years
- Confirmed TCD velocity greater than or equal to 140cm/sec
- Negative serum pregnancy test for subjects of childbearing potential
- Decline transfusions (for subjects with TCD velocity greater than or equal to 200 cm/sec)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
---|
Change in TCD flow velocity
|
Secondary Outcome Measures
Outcome Measure |
---|
Stroke
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sherri Zimmerman, MD, Duke University
Study record dates
Study Major Dates
Study Start
Study Completion
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Hematologic Diseases
- Genetic Diseases, Inborn
- Anemia, Hemolytic, Congenital
- Anemia, Hemolytic
- Hemoglobinopathies
- Stroke
- Anemia
- Anemia, Sickle Cell
- Molecular Mechanisms of Pharmacological Action
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Antineoplastic Agents
- Antisickling Agents
- Hydroxyurea
Other Study ID Numbers
- 4744
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stroke
-
University Hospital, GhentRecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Stroke HemorrhagicBelgium
-
Moleac Pte Ltd.RecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, CryptogenicSingapore, Philippines
-
Moleac Pte Ltd.Not yet recruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, Cryptogenic
-
University of Illinois at ChicagoRecruitingStroke, Ischemic | Stroke Hemorrhagic | Stroke, CerebrovascularUnited States
-
IRCCS San Camillo, Venezia, ItalyRecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke HemorrhagicItaly
-
Vanderbilt University Medical CenterPatient-Centered Outcomes Research Institute; University of Alabama at BirminghamEnrolling by invitationStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Engagement, Patient | Stroke HemorrhagicUnited States
-
University of MinnesotaAmerican Occupational Therapy FoundationRecruitingStroke | Stroke Sequelae | Stroke Hemorrhagic | Stroke IschemicUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Michael Smith Foundation for...RecruitingStroke | Stroke, Ischemic | Stroke Hemorrhagic | Chronic StrokeCanada
-
University of CincinnatiMedical University of South Carolina; University of California, Los Angeles; University...RecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke HemorrhagicUnited States
-
University of LiegeCompletedStroke, Acute | Stroke Hemorrhagic | Stroke, ComplicationBelgium
Clinical Trials on Hydroxyurea
-
Shiraz University of Medical SciencesCompletedCombination Therapy of Hydroxyurea With L-Carnitine and Magnesium Chloride in Thalassemia Intermediaβ-Thalassemia IntermediaIran, Islamic Republic of
-
Vanderbilt University Medical CenterAminu Kano Teaching Hospital; Murtala Muhammed Specialist HospitalCompletedStroke | Sickle Cell Disease | Sickle Cell AnemiaNigeria
-
Ain Shams UniversityUnknownThalassemia IntermediaEgypt
-
Vanderbilt University Medical CenterNational Institute of Neurological Disorders and Stroke (NINDS); Aminu Kano... and other collaboratorsCompletedStroke | Sickle Cell DiseaseNigeria
-
ItalfarmacoCompletedPolycythemia VeraItaly
-
St. Jude Children's Research HospitalTerminatedSickle Cell Disease | ThalassemiaUnited States
-
UNICANCERCompletedBrain and Central Nervous System TumorsFrance
-
St. Jude Children's Research HospitalCompleted
-
St. Jude Children's Research HospitalCompletedAnemia, Sickle CellUnited States
-
Duke UniversityCompleted