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. 2010 Mar;156(3):415-9.
doi: 10.1016/j.jpeds.2009.09.044. Epub 2009 Nov 1.

Adherence to hydroxyurea therapy in children with sickle cell anemia

Courtney D Thornburg  1 , Agustin Calatroni, Marilyn Telen, Alex R Kemper
Affiliations

Adherence to hydroxyurea therapy in children with sickle cell anemia

Courtney D Thornburg et al. J Pediatr. 2010 Mar.

Abstract

Objectives: To assess adherence to hydroxyurea therapy in children with sickle cell anemia (SCA), evaluate the association between adherence and hematologic profile, and identify barriers and facilitators of adherence.

Study design: Children with SCA (n=75) receiving hydroxyurea were recruited for a single-institution cross-sectional study. The primary outcome was association between treatment adherence and percent fetal hemoglobin (HbF).

Results: Good adherence was estimated at 82% with visual analog scale, 84% with Morisky score, 85% with medical provider report, 77% with clinic visits, and 49% on the basis of pharmacy refills. Increase in HbF was moderately associated with good adherence as measured with the parent/proxy Morisky score (r=-0.39; 95% CI, -0.58-0.17; P < .01) and prescription refills (r=0.39; 95% CI, 0.16-0.57; P < .01). The number of pharmacy refills and the Morisky score explained 23% of the variation in HbF response.

Conclusions: Adherence was > or =75% with 4 of 5 measures. Pharmacy refills and the Modified Morisky Scale may be used to identify children at high risk for poor response because of non-adherence and children with good adherence with poor response because of individual pharmacodynamics. Future research should prospectively compare adherence measures and evaluate methods to improve treatment adherence.

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Figures

Figure 1
Figure 1
Scatterplot of Change HbF(%) with Morisky score (Panel A) and Number of Refills (Panel B) adjusted for (dose, age at enrollment and length of treatment). The solid black line represents the best linear fit corresponding to a correlation of −0.39 for the Morisky sum and 0.39 for the number of refills.
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