Improved therapies allow patients with sickle cell disease to live longer, but there is a paucity of research on specific treatment recommendations in older adults and older adults are often underrepresented in clinical trials.
- Older adults are underrepresented in sickle cell disease clinical trials.
- Disease management in older adults must focus on interactions between SCD complications and universal age-related conditions.
- Hydroxyurea is the standard therapy, but more research focused on older adults can inform dosing guidelines and develop tailored treatment plans.
With earlier diagnosis and better disease management, people with sickle cell disease (SCD) are living longer than they could have in the past. However, because SCD life expectancy has been low historically, older adults are severely underrepresented in clinical trials.
The standard therapy for SCD is hydroxyurea, which reduces painful episodes in adults with SCD by 50%. No studies have specifically focused on efficacy in older adults, but it remains the backbone of therapy for all patients. Older patients on hydroxyurea are at a greater risk for leg ulcers, so the risks and benefits of continuing treatment should be closely discussed with providers.
Age-Related Risks and Complications in SCD
All patients, regardless of SCD status, face age-related risk for inflammation, progressive anemia, joint damage, hearing and vision loss, and hematologic malignancies as they get older. These conditions can compound the risk of complications in older adults with SCD and make treatment adherence more difficult, according to a study published in Drugs & Aging.
Polypharmacy, or taking more than 5 regularly prescribed drugs, complicates treatment and increases the risk of falls, hospitalizations, and mortality. All older adults must properly manage their medications, and practitioners must be vigilant about potential drug interactions. For those with SCD, medications and doses should be reviewed regularly, as adverse events could be detrimental to SCD management. Non-pharmacologic intervention should also be utilized when appropriate.
Addressing Research Gaps in SCD Management for Older Adults
More research is needed to determine how disease-modifying therapies and their pharmacokinetics may be different in older adults with SCD in order to improve their quality of life. Given the lack of sufficient data on current and emerging therapies for SCD in older adults, researchers recommend that healthcare providers closely monitor older patients and encourage these patients to report any adverse events that arise during treatment.
Source:
Oyedeji, C. I., Hodulik, K. L., Telen, M. J., & Strouse, J. J. (2023). Management of Older Adults with Sickle Cell Disease: Considerations for Current and Emerging Therapies. Drugs Aging. https://doi.org/10.1007/s40266-023-01014-8