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Sickle Cell Disease: Could Medical Cannabis and Crizanlizumab Prove Helpful?

Two treatments may reduce common pain crises related to SCD

Medical Marijuana

Through a small academic setting survey, researchers at Yale University have discovered that sickle cell disease (SCD) patients are using marijuana to relieve symptoms related to the condition. How the substance is affecting these users and whether SCD should be added to the list of conditions that may be legally treated with medical cannabis is still in question.1 While medical marijuana in the US is legal to alleviate pain caused by several health conditions, only three states (Connecticut, Ohio, and Pennsylvania) include SCD as an approved condition. The Yale survey showed that SCD patients typically use marijuana as an alternative to opioids or supplement other pain relief treatments.

The survey included 58 SCD patients (age 21 and older), seen at an academic medical center, who were anonymously surveyed for their use of marijuana, cocaine, and phencyclidine (angel dust) for pain relief. Of the total study population, 42% reported using marijuana within the past two years; most patients said they used it for medicinal purposes to help with pain, anxiety, appetite, mood, and sleep. In addition, 79% of these patients reported taking less of their pain medications after marijuana use.

Researchers also analyzed urine drug testing for patients participating in the study. Data was available for 57 patients (28 men, 29 women). They found that 18% (10 patients) tested positive for cannabinoid only; 5% (three patients) tested positive for cannabinoid and a combination of cocaine and phencyclidine; and 12% (seven patients) tested positive for cocaine and/or phencyclidine.

“Use of illicit marijuana places persons living with sickle cell disease at risk for both exposure to poisonous contaminants and arrest and incarceration. More widespread inclusion of sickle cell disease as a qualifying condition for medical marijuana might reduce the personal and social costs of illicit marijuana use,” the researchers concluded.

Medical MarijuanaResults of the study could have implications for sickle cell disease to be a legal option for medical marijuana treatment in more US states. (Source: 123RF)

Crizanlizumab

Crizanlizumab, an investigational drug for SCD from Novartis (Basel, Switzerland), has been shown to reduce the number of patients with the disease reporting a pain crisis, including those with a recent history of multiple crises.2 Crizanlizumab is a monoclonal antibody targeting P-selectin, a molecule that exists on the surface of endothelial cells and platelets. P-selectins are responsible for multi-cell adhesion, a key process in the development of vaso-occlusive crisis (VOCs), which may lead to organ damage, failure, and stroke. Crizanlizumab is designed to prevent several cells in the bloodstream from sticking together and blocking blood vessels, reducing the occurrence and severity of VOCs.

The post-hoc analysis reviewed 52-week results from 132 patients; 67 were treated with crizanlizumab 5 mg/kg and 65 received placebo. All evaluated patients had a history of at least two VOCs in the year prior to the study, with 62.9% (n = 83) having experienced 2 to 4 events and 37.1% (n = 49) experiencing 5 to 10 events. The most common genotype in SCD, homozygous hemoglobin S (HbSS), was identified in most patients (n = 94; 71.2%), and patients with this genotype were evenly distributed between study arms.

Adverse events attributed to treatment were similar between the crizanlizumab and placebo arms across all subgroups. Of the subgroups evaluated, a considerable number of patients across multiple subgroups treated with crizanlizumab did not experience a VOC compared with those treated with placebo, including those with:

  • 2 to 4 events in the year prior to participating in the study (17 out of 42 patients, 40.5% vs 10 out of 41 patients, 24.4%)
  • 5 to 10 events in the year prior to participating in the study (7 out of 25 patients, 28.0% vs 1 out of 24 patients, 4.2%)
  • The HbSS genotype (15 out of 47 patients, 31.9% vs 8 out of 47 patients, 17.0%)
  • Concomitant use of hydroxyurea (14 out of 42 patients, 33.3% vs 7 out of 40 patients, 17.5%)

"I am encouraged that results from this post-hoc analysis of SUSTAIN study data found that crizanlizumab could substantially delay or prevent these crises, which also may mean less organ damage in the long run," Abdullah Kutlar, MD, lead author of the study and professor of medicine and director of the Sickle Cell Center at the Medical College of Georgia at Augusta University, said in a press release.3

Last updated on: November 30, 2018
Continue Reading:
Pain Management Dilemmas of Sickle Cell Disease
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