Drug Topics - May 5, 2008 - (Page 5) 5 has the only specialized 24-hour center in the world. Some cities have day clinics: New York City and Fort Lauderdale, for example. A couple of cities are trying to start them: Chicago and Memphis haven’t gotten funding yet. Otherwise, SCD patients may see a hematologist if they’re lucky, or their primary care physician if they can find one who will treat them—and not all hematologists have expertise in SCD.” Without the availability of specialized medical care, SCD patients often wind up in whatever ER that is nearby, in a pain crisis. Platt explained, “Patients with SCD can have chronic pain and then horrible excruciating pain episodes on top of that chronic pain.” But because pain is totally subjective, it’s hard to convince someone unfamiliar with SCD that the pain is real. But he emphasized, “You’ve got to believe them.” Platt stated, “We did a study just tracking true addiction in our adult SCD population. During a five-year span, we were the sole provider of treatment in the city. We found the addiction rate to be about 5% in the SCD population, which is way below the incidence in the general public.” Nevertheless, the amount of pain medication required by an SCD patient in crisis is of concern to a medical professional. To Edwards’ mind, that is a key reason pharmacists and all medical professionals need to encourage SCD patients to have a ‘medical home,’ i.e., a place where they are known and have records. Pharmacists benefit because they have a level of comfort in knowing the prescriber and prescriptions are legitimate “so they can have less insecurity about that patient who comes in with multiple scripts and a large pain medication order,” stated Edwards. It’s also beneficial for the patient who needs the medication. “That’s what [patients are] really concerned about—being treated as a drug seeker. Doctors want to protect their licenses; pharmacists too. But the patient wants quality care.” According to Edwards, “Transfusions, hydration, and hydroxyurea, and then pain management are all part of a standard treatment regimen for SCD.” These measures are used to prevent sickling crises that can cause stroke (even in young children) and end organ damage. Patients themselves need to be cognizant of the need for hydration. Dehydration can readily lead to a SCD crisis. They also need to be aware that their medical provider needs to monitor their iron load so that dehydration doesn't occur. Repeated transfusions—while beneficial in preventing crises— can quickly cause iron overload that can become life-threatening. medicine, a lot of patients are swearing by it, saying ‘This is the best thing DT CAPSULE since sliced bread.’” “I think the reason [deferasirox] is so exciting is it really is a breakthrough to have an oral drug for iron chelation,” said Diane Young, M.D., VP, head, Global Medical Affairs, Novartis Oncology. “Prior to deferasirox, the only chelation therapy available was deferoxamine. It is a very effective drug that chelates iron and removes it from the body, but it is given in a very cumbersome way, by subcutaneous pump. It has a very short half-life and so it has to be given by continuous infusion for a number of hours seven days a week.” Trying to convince children to be adequately compliant with the needed regimen was difficult. In contrast, “deferasirox is an oral drug that is given daily, dissolved in a liquid, and patients can drink it,” she said. One clinical trial in SCD patients compared deferasirox to deferoxamine. Deferasirox proved tolerable and demonstrated efficacy similar to deferoxamine. Currently, some SCD research has zeroed in on drugs SCD patients are at risk for many serious complications. Resources on sickle cell disease For more information, consult the following: Sickle Cell Information Center (NIH Guidelines for treatment, center protocol, education materials, research overview newsletter) www.SCInfo.org Sickle Cell Disease Association of America (resource center for patients, families, medical professionals) www.sicklecelldisease.org (800) 421-8453 Exciting breakthrough Facilitating iron overload treatment is the new oral chelator, deferasirox. Edwards reported, “With this oral already marketed for other uses. Platt commented, “There are some new developments in pulmonary hypertension in SCD (caused by microinfarction over time). Some studies show that sildenafil (Viagra, Pfizer) actually opens pulmonary beds. Other studies have looked at ways to increase nitric oxide (NO), which is low in sickle cell patients, causing vasoconstriction, even in the pulmonary beds. Oral L-arginine is being looked at too. We did a study on high-dose fatty acids and found that they reduced crises. It basically had a platelet-calming effect.” In sum, SCD patients face a multitude of problems. Pharmacists can help patients by learning about the disease and building relationships with them. Relationships go a long ways toward bridging the gap between what can appear to be drug-seeking behavior and the SCD patient getting much-needed care. THE AUTHOR is a medical writer based in the Indianapolis area. http://www.SCInfo.org http://www.sicklecelldisease.org
Table of Contents Feed for the Digital Edition of Drug Topics - May 5, 2008 Drug Topics - May 5, 2008 Contents Don't Get Caught in Fed's Fraud and Abuse Dragnets Sickle Cell Disease: The Hunt is On for a Cure Latest News Roundup Drug Topics - May 5, 2008 Drug Topics - May 5, 2008 - Contents (Page 1) Drug Topics - May 5, 2008 - Contents (Page 2) Drug Topics - May 5, 2008 - Don't Get Caught in Fed's Fraud and Abuse Dragnets (Page 3) Drug Topics - May 5, 2008 - Sickle Cell Disease: The Hunt is On for a Cure (Page 4) Drug Topics - May 5, 2008 - Sickle Cell Disease: The Hunt is On for a Cure (Page 5) Drug Topics - May 5, 2008 - Latest News Roundup (Page 6)
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