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Arginine supplements help against sickle cell disease pain

Presented by
Prof. Richard Onalo, University of Abuja, Nigeria
ASH 2019
New findings indicate that oral arginine serves as a beneficial and widely accessible adjuvant therapy for children with sickle cell anaemia and vaso-occlusive pain episodes [1].

Prof. Richard Onalo (University of Abuja, Nigeria) presented a double-blind, randomised, placebo-controlled trial that investigated the opioid-sparing effects of 100 mg/kg oral L-arginine in the amelioration of severe vaso-occlusive pain episodes (VOE) versus placebo in paediatric patients in sub-Saharan Africa with sickle cell anaemia. Children with sickle cell anaemia (n=68; ages 5-17), scoring at least a 7 of 10 on the Numerical Pain Scale Score (NPRS), received either arginine (n=35) or placebo (n=33) every 8 hours for up to 5 days or 15 doses. Baseline characteristics, including pain scores, were similar between treatment arms. Physicians obtained information including patient demographics, clinical characteristics, length of hospital stay, pain scores, time-to-crisis resolution, analgesia medications required, and plasma amino acid levels. All patients received pain management as needed, with both opioids and non-opioid analgesics.

Mean total analgesic medication quantification scale score (MQS) was significantly lower among arginine-treated patients (73; 95% CI 62-84) than placebo patients (120; 95% CI 97-143; P<0.001). By the fifth day of care, 54% of children treated with arginine had been discharged, versus just 24% of children on placebo. The worst reported pain scores on day 5 were lower in children treated with arginine versus placebo, and the mean rate of pain score decline was greater among treated patients (1.5 vs 1.1 cm/day; P=0.009).

Plasma arginine levels increased significantly among arginine patients compared with placebo (125% vs 29%). Treated patients also experienced a statistically significant decrease in mean total opioid dose use, a shorter time-to-crisis resolution, and a shorter hospital stay.

No serious adverse events were reported in the arginine group; 1 death was reported in the placebo group. More vomiting was reported in the arginine arm versus the placebo arm (20% vs 7%; P=0.07). The team concluded that oral arginine supplement therapy is a promising add-on to the sickle cell anaemia-VOE management.

1. Onalo R, et al. Abstract 301, ASH 2019, 7-10 December, Orlando, USA.

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