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Adherence Outcomes of a Liquid Hydroxyurea Delivery Program in a Pediatric Population
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  • Supriya Sarvode,
  • Maria A. Sacta,
  • Amanuel Kehasse,
  • Suraj Sarvode Mothi,
  • Bhavesh Shah,
  • Amy Sobota
Supriya Sarvode
Boston Medical Center Department of Pediatrics

Corresponding Author:supriya.sarvode@stjude.org

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Maria A. Sacta
Boston Medical Center Department of Pediatrics
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Amanuel Kehasse
Boston Medical Center
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Suraj Sarvode Mothi
Brigham and Women's Hospital Biomedical Research Institute
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Bhavesh Shah
Boston Medical Center
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Amy Sobota
Boston Medical Center Department of Pediatrics
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Abstract

Background: Hydroxyurea remains underutilized in the pediatric sickle cell population despite its well-known efficacy in decreasing sickle cell complications and hospitalizations. Access to refills and liquid formulation remains a critical barrier to adherence to hydroxyurea regimens. This study was undertaken to determine the clinical impact of home-delivering compounded liquid hydroxyurea (LHU) to pediatric patients with sickle cell disease. Procedure/Methods: A retrospective cohort study was conducted using electronic health records and pharmacy databases. Pediatric patients younger than 21 years of hydroxyurea initiation from March 2016 to July 2020 who received compounded LHU from Boston Medical Center Pharmacy were included. The primary outcomes of the study were drug adherence (assessed by evaluating the proportion of days covered), rates of acute care utilization, laboratory values, and growth metrics before and after enrolling in the LHU delivery program. Results: The final cohort included 41 patients. Significant increases in hemoglobin 0.34 g/dl (95% CI: 0.04-0.63, p=0.02) and mean corpuscular volume 3.2 FI (95% CI: 0.92-5.4, p=0.007) occurred. Hospitalizations decreased by 51.3% (p=0.01), and acute chest syndrome episodes decreased by 86.4% (p=0.02) post-initiation of the LHU delivery program. Drug adherence had a median value of 0.95 one-year post-initiation of LHU. Conclusions: Home delivery of compounded LHU improved drug adherence, decreased hospitalizations, and improved laboratory outcomes in pediatric patients with sickle cell disease by overcoming barriers to access. Nationwide implementation of similar home delivery programs can significantly improve outcomes among pediatric patients with sickle cell disease.
11 Mar 2024Submitted to Pediatric Blood & Cancer
12 Mar 2024Submission Checks Completed
12 Mar 2024Assigned to Editor
12 Mar 2024Review(s) Completed, Editorial Evaluation Pending
12 Mar 2024Reviewer(s) Assigned
26 Jul 2024Submission Checks Completed
26 Jul 2024Assigned to Editor
26 Jul 20241st Revision Received
27 Jul 2024Review(s) Completed, Editorial Evaluation Pending
28 Jul 2024Reviewer(s) Assigned
09 Aug 2024Editorial Decision: Revise Major
23 Aug 20242nd Revision Received
23 Aug 2024Submission Checks Completed
23 Aug 2024Assigned to Editor
24 Aug 2024Review(s) Completed, Editorial Evaluation Pending
26 Aug 2024Reviewer(s) Assigned
31 Aug 2024Editorial Decision: Revise Minor
09 Sep 2024Submission Checks Completed
09 Sep 2024Assigned to Editor
09 Sep 20243rd Revision Received
10 Sep 2024Review(s) Completed, Editorial Evaluation Pending
11 Sep 2024Editorial Decision: Accept