Evaluation of the combination therapy of hydroxyurea and thalidomide in β-thalassemia

Saqib H Ansari, Iqra Ansari, Misbah Wasim, Amjad Sattar, Shariqa Khawaja, Muhammad Zohaib, Zeeshan Hussain, Syed Omair Adil, Ali H Ansari, Usman H Ansari, Fawad Farooq, Noor-Un-Nisa Masqati, Saqib H Ansari, Iqra Ansari, Misbah Wasim, Amjad Sattar, Shariqa Khawaja, Muhammad Zohaib, Zeeshan Hussain, Syed Omair Adil, Ali H Ansari, Usman H Ansari, Fawad Farooq, Noor-Un-Nisa Masqati

Abstract

Transfusion-related complications and lack of resources in low-to-middle-income countries have led to a search for novel therapies to reduce the need for blood transfusions in patients with β-thalassemia. Hydroxyurea (HU) has demonstrated promising outcomes; additionally, thalidomide has also shown improvement in hemoglobin (Hb) levels for patients with β-thalassemia in some studies. This study presents the findings of a single-arm nonrandomized trial to evaluate the efficacy of combination therapy of HU and thalidomide in children with β-thalassemia. A total of 135 patients (median age, 6 [interquartile range, 3-10] years), 77 (57%) males and 58 (43%) females, were followed first using HU alone, for 6 months, and then using the combination of HU and thalidomide for another 6 months. The primary outcome was a response to therapy, as measured by the number of transfusions required and Hb levels, for patients while receiving HU alone and then while using the combination therapy. Study findings showed a significant decline in blood transfusion volume (P < .001) and a significant increase in median Hb levels within 3 and 6 months of the combination therapy (P < .001). Eighty-nine (65.93%) participants were good responders, 16 (11.85%) were responders, and 30 (22.22%) were nonresponders, whereas the responders had variable genetic mutations. A total of 38 adverse events were reported that resolved on supportive treatment or temporary hold of the intervention. The combination therapy demonstrated promising results and could be considered for a diverse patient population with β-thalassemia. This trial was registered at www.clinicaltrials.gov as #NCT05132270.

Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Comparison of response with respect to mutations (n = 135).

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