Article
Author: Kamberos, Natalie L. ; Godder, Kamar ; Fuh, Beng R. ; Casella, James F. ; Inati, Adlette ; Almomen, Abdulkareem M. ; Lasky, Joseph L. ; de Julian, Elena Cela ; Thornburg, Courtney Dawn ; Goyal-Khemka, Meenakshi ; Kronsberg, Shari S. ; Shah, Nirmish ; de Castro Lobo, Clarisse Lopes ; Wali, Yasser ; Parsley, Ed ; Black, L. Vandy ; Hsu, Lewis L. ; Gorney, Rebecca T. ; Emanuele, Marty ; Noronha, Suzie A. ; Padgett, Claire S. ; Morris, Claudia R. ; Pace, Betty S. ; Thompson, Alexis A. ; Schaefer, Anne ; Tebbi, Cameron K. ; Singleton, Tammuella C. ; Sarnaik, Sharada A. ; George, Alex ; Alvarez, Ofelia A. ; Nuss, Rachelle ; Gladwin, Mark T. ; Keates-Baleeiro, Jennifer ; Barton, Bruce A. ; Raj, Ashok ; Kilinc, Yurdanur ; Takemoto, Clifford M. ; Quinn, Charles T. ; Kanter, Julie ; Chantrain, Christophe F. ; Al-Khabori, Murtadha K. ; Majumdar, Suvankar ; Sisler, India Y. ; Owen, William C. ; Drachtman, Richard A. ; Moulton, Thomas ; Cohen, Debra E. ; Kato, Gregory J. ; Piccone, Connie M. ; Maes, Philip ; Abboud, Miguel R. ; Salman, Emad ; Fixler, Jason M. ; Marsh, Anne M. ; Karakas, Zeynep
ImportanceAlthough effective agents are available to prevent painful vaso-occlusive episodes of sickle cell disease (SCD), there are no disease-modifying therapies for ongoing painful vaso-occlusive episodes; treatment remains supportive. A previous phase 3 trial of poloxamer 188 reported shortened duration of painful vaso-occlusive episodes in SCD, particularly in children and participants treated with hydroxyurea.ObjectiveTo reassess the efficacy of poloxamer 188 for vaso-occlusive episodes.Design, Setting, and ParticipantsPhase 3, randomized, double-blind, placebo-controlled, multicenter, international trial conducted from May 2013 to February 2016 that included 66 hospitals in 12 countries and 60 cities; 388 individuals with SCD (hemoglobin SS, SC, S-β0 thalassemia, or S-β+ thalassemia disease) aged 4 to 65 years with acute moderate to severe pain typical of painful vaso-occlusive episodes requiring hospitalization were included.InterventionsA 1-hour 100-mg/kg loading dose of poloxamer 188 intravenously followed by a 12-hour to 48-hour 30-mg/kg/h continuous infusion (n = 194) or placebo (n = 194).Main Outcomes and MeasuresTime in hours from randomization to the last dose of parenteral opioids among all participants and among those younger than 16 years as a separate subgroup.ResultsOf 437 participants assessed for eligibility, 388 were randomized (mean age, 15.2 years; 176 [45.4%] female), the primary outcome was available for 384 (99.0%), 15-day follow-up contacts were available for 357 (92.0%), and 30-day follow-up contacts were available for 368 (94.8%). There was no significant difference between the groups for the mean time to last dose of parenteral opioids (81.8 h for the poloxamer 188 group vs 77.8 h for the placebo group; difference, 4.0 h [95% CI, -7.8 to 15.7]; geometric mean ratio, 1.2 [95% CI, 1.0-1.5]; P = .09). Based on a significant interaction of age and treatment (P = .01), there was a treatment difference in time from randomization to last administration of parenteral opioids for participants younger than 16 years (88.7 h in the poloxamer 188 group vs 71.9 h in the placebo group; difference, 16.8 h [95% CI, 1.7-32.0]; geometric mean ratio, 1.4 [95% CI, 1.1-1.8]; P = .008). Adverse events that were more common in the poloxamer 188 group than the placebo group included hyperbilirubinemia (12.7% vs 5.2%); those more common in the placebo group included hypoxia (12.0% vs 5.3%).Conclusions and RelevanceAmong children and adults with SCD, poloxamer 188 did not significantly shorten time to last dose of parenteral opioids during vaso-occlusive episodes. These findings do not support the use of poloxamer 188 for vaso-occlusive episodes.Trial RegistrationClinicalTrials.gov Identifier: NCT01737814.