Realizing Effectiveness Across Continents with Hydroxyurea(REACH): A Phase I/II Pilot Study of Hyroxyurea for Children with Sickle Cell Anemia

利用羟基脲 (REACH) 在各大洲实现有效性：羟基脲治疗镰状细胞性贫血儿童的 I/II 期初步研究

• 批准号: 10001581
• 负责人: Russell E Ware
• 金额: $ 67.62万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10001581
• 关键词: 10 year old; 5 year old; Address; Adherence; Affect; Africa; Africa South of the Sahara; African; Angola; Bacterial Infections; Birth; Blood; Blood specimen; Caring; Characteristics; Child; Child Mortality; Clinic Visits; Clinical; Clinical and Translational Science Awards; Collaborations; Collection; Country; Data; Database Management Systems; Databases; Developed Countries; Development; Diagnosis; Disease; Dose; Drug Kinetics; Education; Effectiveness; Enrollment; Europe; Event; Family; Fetal Hemoglobin; Frequencies; Future; Genetic; Goals; Growth; Health; Healthcare; Hematological Disease; Hematology; Hemoglobinopathies; Immunization; Infant; Infection; Inherited; Intervention; Investigation; Kenya; Laboratories; Lead; Life; Location; Maintenance; Malaria; Malnutrition; Maximum Tolerated Dose; Measures; Medical; Medicine; Monitor; Morbidity - disease rate; Multicenter Trials; Multilingualism; Neonatal Screening; Newborn Infant; Nutritional status; Oral; Outcomes Research; Participant; Patients; Penicillins; Pharmaceutical Preparations; Pharmacodynamics; Pharmacogenomics; Phase; Physicians; Pilot Projects; Process; Prophylactic treatment; Prospective Studies; Protocols documentation; Publishing; Renal function; Research; Research Design; Research Infrastructure; Research Personnel; Research Project Grants; Resources; Role; Safety; Savings; Science; Severities; Sickle Cell Anemia; Sickle Cell Trait; Site; Standardization; Sustainable Development; Talents; Testing; Toxic effect; Training; Uganda; United States; World Health Organization; burden of illness; clinical research site; cohort; comorbidity; cost effective; design; evidence base; exome; exome sequencing; experience; genetic variant; genome sequencing; hydroxyurea; individual patient; infancy; innovation; insight; interpatient variability; investigator training; malaria infection; mortality; next generation; next generation sequencing; novel; patient variability; preventable death; programs; research study; response; safety and feasibility; safety testing; screening; screening program; sickling; trait; treatment guidelines; treatment program; treatment response; virtual

ABSTRACT Sickle cell anemia (SCA) is among the world’s most common inherited blood disorders, and causes both morbidity and early mortality. SCA is highly prevalent in Africa, affecting over 300,000 births annually, with projections for an increasing burden in the next generation. In the US, infants with SCA are identified by newborn screening; simple interventions have dramatically reduced morbidity and mortality. In Africa, by contrast, neonatal screening is not available, and most affected infants will die before age 5 years, without proper diagnosis and treatment of SCA. The World Health Organization (WHO) notes SCA contributes substantially to under-5 mortality for many African countries. Several pilot SCA screening programs have begun in sub-Saharan Africa, which document a large burden (10-25% sickle trait and 1-2% SCA). With better screening and early care and treatment programs, more children with SCA in Africa will likely survive, but their medical needs will strain the limited healthcare resources. Accordingly, there is an urgent need to investigate the role of hydroxyurea for children with SCA in Africa, since hydroxyurea is the only realistic and affordable disease-modifying therapy in this setting. To date, hydroxyurea has been studied only in developed countries, with virtually no data available regarding its safe and effective use in Africa. To address this critical unmet need, we developed and launched the REACH (Realizing Effectiveness Across Continents with Hydroxyurea) trial, ClinicalTrials.gov NCT01966731, a prospective study of hydroxyurea designed to gather critical data regarding the safety, feasibility, and benefits of hydroxyurea for young children in sub-Saharan Africa. REACH is also designed to gather important data about why children have different responses to hydroxyurea treatment; using novel and innovative approaches, we will collect data regarding the inter-patient variability by analysis of hydroxyurea pharmacokinetics, pharmacodynamics, and pharmacogenomics. A total of 600 children with SCA between 1-10 years of age will enroll and first receive fixed dose hydroxyurea, then dose escalation to the maximum tolerated dose (MTD), followed by maintenance treatment to a common study termination date. We have obtained all drug supply in donation from Bristol-Myers Squibb, performed a rigorous site selection process to identify sites able to perform high-quality research, and four locations (Luanda Angola, Kinshasa DRC, Kilifi, Kenya; and Mbale, Uganda) are actively enrolling children and providing protocol-directed hydroxyurea treatment. Using an adaptive study design and the REDCap electronic database system through our Clinical & Translational Science Award program, we are collecting data on the safety, feasibility, and benefits of hydroxyurea for SCA within Africa. We will also collect novel information about inter-patient variability by creating a hydroxyurea pharmacokinetics profile for each participant, and then investigate associations with pharmacodynamics parameters like HbF responses. We will also perform Whole Exome Sequencing on this cohort, to allow pharmacogenomics analysis that should yield important insights into the variable treatment responses. Over the long term, the REACH trial will teach local African physicians how to administer hydroxyurea and help establish a robust research infrastructure for future collaborations. REACH data will provide better understanding and characterization of inter-patient variability of hydroxyurea-related toxicities and responses, and will guide future research and evidence-based hydroxyurea treatment guidelines for wider usage in Africa.

抽象的 镰状细胞贫血（SCA）是世界上最常见的血液疾病之一，并引起发病率和早期 死亡。 SCA在非洲高度普遍，每年影响超过300,000次出生，燃烧的项目越来越多 下一代。在美国，通过新生儿筛查确定患有SCA的婴儿；简单的干预措施急剧 发病率和死亡率降低。相比之下，在非洲，新生儿筛查不可用，大多数受影响的婴儿将 在5岁之前死亡，没有适当的SCA诊断和治疗。世界卫生组织（WHO）指出SCA 许多非洲国家为5岁以下的死亡率做出了重大贡献。几个试点SCA筛查计划已经开始 撒哈拉以南非洲，记录了大烧伤（10-25％的镰刀特征和1-2％的SCA）。进行更好的筛查和早期护理 和治疗计划，非洲有更多SCA的儿童可能会生存，但他们的医疗需求将使极限紧张 医疗保健资源。彼此之间，迫切需要调查羟基脲对SCA儿童的作用 非洲，因为在这种情况下，羟基脲是唯一现实且负担得起的疾病改良疗法。迄今为止，羟基脲 仅在发达国家进行了研究，几乎没有有关其在非洲安全有效使用的数据。到 满足了这种关键的未满足需求，我们开发并启动了覆盖范围（实现了各大洲的有效性 羟基脲）试验，临床。 关于羟基脲对撒哈拉以南非洲幼儿的安全性，可行性和益处。覆盖范围也是设计的 收集有关儿童为何对羟基脲治疗有不同反应的重要数据；使用小说和创新 方法，我们将通过分析羟基脲药代动力学的分析来收集有关患者间变异性的数据， 药效学和药物基因组学。总共有600名SCA儿童在1-10岁之间将注册，首先 接受固定剂量羟基脲，然后剂量升级为最大耐受剂量（MTD），然后进行维护 治疗常见的研究终止日期。我们从Bristol-Myers Squibb的捐赠中获得了所有药物供应， 进行了严格的现场选择过程，以识别站点可以进行高质量研究和四个地点（Luanda） 安哥拉，金沙萨刚果民主共和国，基利比，肯尼亚；和乌干达的姆巴莱）正在积极注册儿童，并提供协议定向 羟基脲处理。使用自适应研究设计和RedCap电子数据库系统通过我们的临床和 转化科学奖计划，我们正在收集有关羟基脲对SCA的安全性，可行性和益处的数据 在非洲。我们还将通过创建羟基脲药代动力学来收集有关患者间可变性的新颖信息 每个参与的轮廓，然后研究与HBF响应（例如HBF响应）的药物动力学参数的关联。我们将 还要在该队列上执行整个外显子组测序，以允许药物基因组学分析，应产生重要 洞悉可变治疗反应。从长远来看，REACH审判将教非洲当地医生如何 管理羟基脲，并帮助建立强大的研究基础架构，以实现未来的合作。到达数据将 提供更好地理解和表征与羟基脲相关毒性的患者间变异性和 反应，并将指导未来的研究和基于证据的羟基脲治疗指南，以实现非洲的更广泛使用。