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Systematic Review of Crizanlizumab: A New Parenteral Option to Reduce Vaso‐occlusive Pain Crises in Patients with Sickle Cell Disease
Author(s) -
Han Jin,
Saraf Santosh L.,
Gordeuk Victor R.
Publication year - 2020
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2409
Subject(s) - medicine , incidence (geometry) , placebo , sickle cell anemia , vaso occlusive crisis , population , clinical trial , disease , dosing , anemia , concomitant , adverse effect , pathology , alternative medicine , physics , environmental health , optics
Hydroxyurea, indicated for managing sickle cell anemia (SCA), and L‐glutamine, indicated for treating sickle cell disease (SCD), were the only pharmacotherapeutic options in this patient population before the approval of crizanlizumab by the U.S. Food and Drug Administration in November 2019 to reduce vaso‐occlusive crisis (VOC) frequency. This article reviews the evidence pertaining to crizanlizumab in SCD by searching records in Medline, Embase, and International Pharmaceutical Abstracts. Crizanlizumab, a P‐selectin inhibitor, mitigates the microvascular vaso‐occlusion in SCD. In the multicenter randomized double‐blind SUSTAIN trial, a higher dose of crizanlizumab decreased the incidence of VOCs by 45% and prolonged the median time to the first and second VOC. A post hoc subgroup analysis demonstrated that the proportion of patients who had no VOC incidence during the study period was greater in the crizanlizumab group, and this benefit was consistent regardless of concomitant hydroxyurea use, prior categorized history of VOC frequency, or SCD genotype. Crizanlizumab had a safety profile comparable with placebo. Multiple ongoing clinical trials are trying to establish its roles in pediatric patients with SCD and its effects on alleviating other SCD‐related complications. As the first parenteral option for SCD, providers need to formulate administration logistics to improve patients’ access to crizanlizumab. Current available data suggest crizanlizumab is a promising agent to reduce VOC in patients with SCD.