Affordable Access

deepdyve-link
Publisher Website

Systematic Review of l-glutamine for Prevention of Vaso-occlusive Pain Crisis in Patients with Sickle Cell Disease.

Authors
  • Cieri-Hutcherson, Nicole E1
  • Hutcherson, Timothy C2
  • Conway-Habes, Erin E3
  • Burns, Brianna N4
  • White, Nathan A4
  • 1 Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Science, University at Buffalo, Buffalo, New York.
  • 2 Department of Pharmacy Practice, D'Youville College School of Pharmacy, Drug Information Center, Buffalo, New York.
  • 3 Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, Buffalo, New York.
  • 4 D'Youville School of Pharmacy, Buffalo, New York.
Type
Published Article
Journal
Pharmacotherapy
Publication Date
Nov 01, 2019
Volume
39
Issue
11
Pages
1095–1104
Identifiers
DOI: 10.1002/phar.2329
PMID: 31505045
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

l-glutamine was approved by the U.S. Food and Drug Administration (FDA) for sickle cell disease (SCD) in 2017. A vaso-occlusive crisis (VOC) occurs in persons with SCD and is associated with acute pain episodes. This systematic review summarizes the evidence for l-glutamine in the prevention of VOC and associated pain in patients with SCD. Medline, Embase, and International Pharmaceutical Abstracts were searched for records reporting on l-glutamine use in persons with SCD. Eligibility criteria identified primary reports of investigations conducted in humans who were administered l-glutamine, reported on outcomes related to VOC or associated pain, published in English, and were available as full text. All relevant efficacy, safety, participant demographic data, and study method characteristics were extracted and documented. Risk-of-bias assessments were conducted using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool and the revised Cochrane risk-of-bias tool for randomized studies. Three studies assessing the effect of exogenous l-glutamine administration in patients with SCD met eligibility criteria: one prospective nonrandomized controlled study and two prospective randomized controlled trials. Rate of VOC and related hospitalizations were reduced in patients receiving l-glutamine, although some conflicting results were noted between studies. l-glutamine was generally well tolerated. Limitations of one or more of the eligible studies included small sample size, nonblinding, and study groups that differed at baseline. l-glutamine has limited high-quality evidence supporting its use. Although l-glutamine is FDA approved for the prevention of frequent episodes of VOC pain, only one randomized controlled trial has strong evidence to support this indication. Based on the results of a systematic review, l-glutamine may be considered for patients unable to receive hydroxyurea or in addition to hydroxyurea for reduction in VOC and associated pain. © 2019 Pharmacotherapy Publications, Inc.

Report this publication

Statistics

Seen <100 times