Double-blind randomised clinical trial of pentoxiphyllin in vaso-occlusive sickle cell crisis

Frequent painful sickle cell crisis leads to a high number of active days lost due to morbidity or mortality. Only one of the specific drugs has been shown to be efficacious in a controlled clinical trial in the USA. The efficacy and the appropriateness of a drug acting on the erythrocytic membrane, pentoxiphyllin, was investigated in a randomised, double blinded clinical trial in the treatment of acute incapacitating crisis. In the 36 patients studied in a rural hospital in Togo (West Africa) where sickle cell disease is frequent (0.51% of all births), the mean (standard deviation = SD) duration of inpatient treatment was significantly shorter in the actively treated group active drug: 77.6 (40.19) hours, placebo: 102.4 (25.31) hours, difference between means: 24.8 (95% confidence intervals (= 95% CI) 2.02-47.5) hours); p = 0.03. This marked effect of active treatment was evident during the first 48 hours only. The suitability of this therapeutic regime within the studied area is discussed.