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| Name | Class |
|---|---|
| Benisuef university hospital | UNKNOWN |
| University of Arizona | OTHER |
| Maternity and Children Hospital, Makkah | OTHER |
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The aim of the present study is comparing the effectiveness of different treatment regimens for investigating the therapeutic potential for each one in management of Vaso-occlusive pain in pediatric sickle cell disease. In addition, investigators apply the Cost-effectiveness analysis (CEA) as a form of economic analysis that compares the relative costs and outcomes (effects) for different treatment regimens on vaso-occlusive painful crisis.
"Sickle cell disease is an inherited blood disorder characterized by defective hemoglobin (a protein in red blood cells that carries oxygen to the tissues of the body).
Sickle cell disease involves the red blood cells, or hemoglobin, and their ability to carry oxygen. Normal hemoglobin cells are smooth, round, and flexible, like the letter "O," so they can move through the vessels in our bodies easily. Sickle cell hemoglobin cells are stiff and sticky and form into the shape of a sickle, or the letter "C," when they lose their oxygen. These sickle cells tend to cluster together and cannot easily move through the blood vessels. The cluster causes a blockage in small arteries or capillaries and stops the movement of healthy, normal oxygen-carrying blood. This blockage is what causes the painful and damaging complications of sickle cell disease".
"Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple complex pathophysiological processes can result in pain during a VOC. Despite significant improvements in the understanding and management of SCD, little progress has been made in the management of pain in SCD, although new treatments are being explored".
The Painful Episodes:
"The day-to-day management of sickle cell disease often equates with the management of acute and chronic pain. Patients manage many painful events at home so that hospital visits underestimate the frequency of pain
Acute painful episodes are the most commonly encountered vaso-occlusive events in patients of all ages. Presumed to be caused by sickle vaso-occlusion, pain often starts in young children as the hand-foot syndrome or dactylitis, a painful swelling of hands and feet due to inflammation of the metacarpal and metatarsal periosteum. Painful episodes, which last from hours to many days, usually occur with little warning and a clear precipitating event is not often found.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Omega-3 experimental group | Experimental | 50 patients from each participating hospital that will receive Omega-3 supplementation (300-400mg EPA & 200-300mg DHA) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
| Vit-D experimental group | Experimental | 50 patients from each participating hospital that will receive Vit-D medication (1500 IU to 3500 IU ) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
| Zinc supplements experimental group | Experimental | 50 patients from each participating hospital that will receive Zinc supplements (15 mg to 50 mg ) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Omega 3 | Drug | Omega-3 supplementation (300-400mg EPA & 200-300mg DHA) per day for 8 consecutive months up to 10 months |
|
| Measure | Description | Time Frame |
|---|---|---|
| C-reactive protein mg/L | C-reactive protein milligrams per deciliter | 10 months |
| Hematocrit % | Hematocrit level in percentage value | 10 months |
| Fibrinogen mg/dl | Fibrinogen concentration in milligrams per deciliter | 10 months |
| Total cholesterol Mg/dl | Total cholesterol milligrams per deciliter | 10 months |
| HDL cholesterol Mg/dl | HDL cholesterol milligrams per deciliter | 10 months |
| LDL cholesterol Mg/dl | LDL cholesterol milligrams per deciliter | 10 months |
| Triglycerides Mg/dl | Triglycerides milligrams per deciliter | 10 months |
| leukocytes count μl | leukocytes in microliter | 10 months |
| hemoglobin (Hbg) g/dL | hemoglobin (Hbg) gram/deciliter |
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Inclusion Criteria:
Any case with the full manifestation of sickle cell disease accompanied by acute painful crisis aged from 5-15 years old.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| John E. Murphy [Professor of Pharmacy Practice and Science], PharmD | University of Arizona, College of Pharmacy | Study Director |
| Mohamed H Meabad [Prof of Pediatrics], M.D | Beni-Suef University, Faculty of medicine | Study Director |
| AHMED A ALBERRY [Assistant prof of clinical pharmacology], M.D | Beni-Suef University, Faculty of medicine | Study Director |
| RAGHDA R SAYED [Lecturer of Clinical Pharmacy, Ph.D. | Beni-Suef University, Faculty of Pharmacy | Study Director |
| Shaimaa M Nashat Sayed Abdelhalim, Ph.D Student | Beni-Suef University, Faculty of Pharmacy | Principal Investigator |
| Ahmed F Mahmoud Hussein, MS.c | Beni-Suef Health insurance hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of medicine, Beni-suef univeristy - Beni-Seuf university hospital | Banī Suwayf | Egypt | ||||
| Faculty of Pharmacy, Beni-Suef university |
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Four experimental groups, one control group
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| Statin experimental group | Experimental | 50 patients from each participating hospital that will receive Simvastatin orally (20 mg to 40 mg ) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
| Ordinary hospital treatment group | Active Comparator | 50 patients from each participating hospital that will receive the ordinary treatment of Hydroxyurea (20 mg/kg/day) with monitoring blood count every 2 weeks maximum daily dose: (40 mg/kg/day) for 8 consecutive months up to 10 months. in addition, Folic Acid dose of 0.5 to 1 mg daily for 3 to 4 weeks until definite hematologic response in addition, Morphine medication as a pain killer is administered, if Patient weight <50 kg: Opioid naïve: Initial: 0.05 mg/kg/dose; usual maximum initial dose: 1 to 2 mg/dose. This group received regular blood transfusion session. |
|
| Vit D | Drug | 50 patients from each participating hospital that will receive Vit-D medication (1500 IU to 3500 IU ) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
|
| Zinc sulfate | Drug | 50 patients from each participating hospital that will receive Zinc supplements (15 mg to 50 mg ) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
|
| Statins (Cardiovascular Agents) | Drug | 50 patients from each participating hospital that will receive Simvastatin orally (20 mg to 40 mg ) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of hydroxyurea, Folic acid, pain killer plus regular blood transfusion with a dose de-escalation methods till efficacy of experimental treatment proved. |
|
|
| Hydroxy Urea | Drug | 50 patients from each participating hospital that will receive the ordinary treatment of Hydroxyurea (20 mg/kg/day) with monitoring blood count every 2 weeks maximum daily dose: (40 mg/kg/day) for 8 consecutive months up to 10 months. |
|
|
| Folic Acid Supplementation | Drug | Folic Acid dose of 0.5 to 1 mg daily for 3 to 4 weeks until definite hematologic response |
|
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| Morphine Sulfate | Drug | Morphine medication as a pain killer is administered, if Patient weight <50 kg: Opioid naïve: Initial: 0.05 mg/kg/dose; usual maximum initial dose: 1 to 2 mg/dose. |
|
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| blood transfusion session | Procedure | Regular blood transfusion session based on patient hematological profile starts from one session every 2 weeks. |
|
| 10 months |
| White blood cells count | White blood cells count in a cubic milliliter of blood | 10 months |
| Lactic acid dehydrogenase U/L | Lactic acid dehydrogenase unit per litter | 10 months |
| Reticulocyte count % | Reticulocyte count percentage | 10 months |
| Red blood cell (erythrocyte ) sedimentation rate mm/hr | erythrocyte sedimentation rate in millimeters (mm) per one hour(hr) | 10 months |
| lymphocyte count µL | lymphocyte count in 1 microliter (µL) of blood | 10 months |
| Granulocyte absolute count cells/microliter | Granulocyte cells numbers in microliter | 10 months |
| Granulocytes,percentage (GR, pct) | percentage of white blood cells with granules in percentage | 10 months |
| Banī Suwayf |
| Egypt |
| Health insurance hospital | Banī Suwayf | Egypt |
| Maternity and Children hospital | Mecca | Saudi Arabia |
| ID | Term |
|---|---|
| D000098644 | Vaso-Occlusive Crises |
| D000755 | Anemia, Sickle Cell |
| ID | Term |
|---|---|
| D000745 | Anemia, Hemolytic, Congenital |
| D000743 | Anemia, Hemolytic |
| D000740 | Anemia |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D006453 | Hemoglobinopathies |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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| ID | Term |
|---|---|
| D004281 | Docosahexaenoic Acids |
| D019287 | Zinc Sulfate |
| D019161 | Hydroxymethylglutaryl-CoA Reductase Inhibitors |
| D002317 | Cardiovascular Agents |
| D019821 | Simvastatin |
| D006918 | Hydroxyurea |
| D009020 | Morphine |
| ID | Term |
|---|---|
| D015525 | Fatty Acids, Omega-3 |
| D004042 | Dietary Fats, Unsaturated |
| D004041 | Dietary Fats |
| D005223 | Fats |
| D008055 | Lipids |
| D005231 | Fatty Acids, Unsaturated |
| D005227 | Fatty Acids |
| D005395 | Fish Oils |
| D009821 | Oils |
| D013431 | Sulfates |
| D013464 | Sulfuric Acids |
| D013456 | Sulfur Acids |
| D013457 | Sulfur Compounds |
| D007287 | Inorganic Chemicals |
| D017967 | Zinc Compounds |
| D000924 | Anticholesteremic Agents |
| D000960 | Hypolipidemic Agents |
| D000963 | Antimetabolites |
| D045504 | Molecular Mechanisms of Pharmacological Action |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
| D004791 | Enzyme Inhibitors |
| D057847 | Lipid Regulating Agents |
| D045506 | Therapeutic Uses |
| D008148 | Lovastatin |
| D009281 | Naphthalenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D011083 | Polycyclic Compounds |
| D014508 | Urea |
| D000577 | Amides |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
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