The July 7, 2005 issue of NEJM reports a RCT in which cases of essential thrombocythemia at risk for thrombosis were treated with either hydroxyurea plus ASA or anagrelide plus ASA. The hydroxyurea arm was better in almost everyway. There were fewer arterial thromboses, fewer serious hemorrhages and fewer withdrawals from therapy in the hydroxyurea group while the anagrelide group had fewer venous thromboses. Essential thrombocythemia manages to pose a risk of both hemorrhage and thrombosis, the former occurring at the higher platelet counts. Concern about the potential leukemogenic effect of alkalating agents lead to the development and clinical application of anagrelide which apparently only affects the platelets, doing little or no harm to the red and white cells. Anagrelide seemed a reasonable replacement from hydroxyurea. However, this RCT strongly suggests otherwise. This was the first head- to- head comparison of the two treatments and although urea was not better in every measured way,
on balance it appears a better choice.
1 comment:
Interferon alpha compared to hydroxyurea has the potential to improve the clinical picture and reduce pruritus, but most importantly it can selectively reverse the deviant chromosomes involved, and it can delay or stop the development of agnogenic myeloid metaplasia. Hydroxyurea has some real negatives such as skin problems, unlike interferon, it controls counts but not the disease process.
Please remember that I am not a physician. Always check with your hematologist if you have questions, and if he or she is not available, discuss your concerns with the oncology nurse.
Robert
Listowner Myeloproliferative disease support web site and daily digest.
http://members.aol.com/mpdsupport
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