The Evolving Pharmacotherapeutic Landscape for the Treatment of Sickle Cell Disease

Samir K Ballas, Samir K Ballas

Abstract

Sickle cell disease (SCD) is an extremely heterogeneous disease that has been associated with global morbidity and early mortality. More effective and inexpensive therapies are needed. During the last five years, the landscape of the pharmacotherapy of SCD has changed dramatically. Currently, 54 drugs have been used or under consideration to use for the treatment of SCD. These fall into 3 categories: the first category includes the four drugs (Hydroxyurea, L-Glutamine, Crizanlizumab tmca and Voxelotor) that have been approved by the United States Food and Drug Administration (FDA) based on successful clinical trials. The second category includes 22 drugs that failed, discontinued or terminated for now and the third category includes 28 drugs that are actively being considered for the treatment of SCD. Crizanlizumab and Voxelotor are included in the first and third categories because they have been used in more than one trial. New therapies targeting multiple pathways in the complex pathophysiology of SCD have been achieved or are under continued investigation. The emerging trend seems to be the use of multimodal drugs (i.e. drugs that have different mechanisms of action) to treat SCD similar to the use of multiple chemotherapeutic agents to treat cancer.

Keywords: Pharmacotherapeutic; Sickle cell disease.

Conflict of interest statement

Competing interests: The authors declare no conflict of Interest.

Figures

Figure 1
Figure 1
Sequence of complications of sickle cell anemia from birth through adult life. ACS = acute chest syndrome; AVN = Avascular necrosis; CVA = Cerebrovascular accident. From Hem Onc Clin North Am. 2005; 19:785–802. Used with permission.
Figure 2
Figure 2
Fingernails of a 38-year-old man with sickle cell anemia and hydroxyurea-induced melanonychia characterized by longitudinal (blue arrow) and diffuse (red arrow) bands. From J Blood Disorders Transf. 2013;4:5. Used with permission.
Figure 3
Figure 3
Randomized phase 2 trial of Regadenoson for treatment of acute vaso-occlusive crises in sickle cell disease. From Blood Adv. 2017;1(20):1645–9. Used with permission.

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