Exploratory findings from the randomized double-blind placebo-controlled multicenter study of hydroxyurea (MSH) in sickle cell anemia (SS). Recurrent acute painful crises may be mild, moderate or severe in nature and often require treatment at home, in acute care facilities as outpatients, and in the hospital with oral and/or parenteral opioids.
The objectives of this study were to determine the effects of hydroxyurea (HU) on length of hospital stay (LOS) and opioid utilization during hospitalization, outpatient acute care contacts, and at home.
Data from patient diaries, follow-up visit forms and medical contact forms on the 299 patients enrolled in the MSH were analyzed. Types and dosages of at-home, acute care, and in-hospital analgesic usage were explored descriptively.
At home analgesics were used on 40% of diary days and 80% of two-week follow-up periods, with oxycodone and codeine the most frequently used. Responders to HU used analgesics on fewer days. During hospitalization, 96% were treated with parenteral opioids, with meperidine the most frequently used; oxycodone was the most commonly used oral medication. The average LOS for responders to HU was about two days less than for other groups and their cumulative time hospitalized during the trial was significantly less than for nonresponders or placebo groups (P<0.022). They also had the lowest doses of parenteral opioids during acute care crises (P=0.015).
Beneficial effects of HU include shortening the duration of hospitalization due to acute painful episodes and reducing the net amount of opioid utilization.