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Evaluation of Glutamine Utilization in Patients With Sickle Cell Disease
Han-Wei Wu1, Michael Gannon2, Lewis L Hsu3
1Department of Pediatrics.
Insights
Glutamine (Gln) improves sickle cell disease (SCD) adherence compared to other medications. An interdisciplinary approach may help overcome access barriers and ensure sustained management of this therapy.
Area of Science:
- Hematology
- Pharmacology
- Public Health
Background:
- Glutamine (Gln) is FDA-approved for sickle cell disease (SCD).
- Pediatric SCD patients often show suboptimal adherence (<80% medication possession ratio).
- Real-world utilization and adherence factors for Gln are not well-defined.
Purpose of the Study:
- To examine Gln utilization in a real-world clinical setting.
- To identify factors influencing Gln medication adherence in SCD patients.
- To assess the impact of an interdisciplinary team approach on Gln management.
Main Methods:
- Retrospective chart review of 40 patients prescribed Gln by sickle cell specialists over 2 years.
- Analysis of medication possession ratio (MPR), insurance approval rates, and medication fills.
- Assessment of patient satisfaction and reported side effects.
Main Results:
- Gln MPR was higher in pediatric (72%) and adult (76%) patients compared to other SCD medications.
- Pediatric patients faced significantly lower first-attempt insurance approval rates (74%) versus adults (95%).
- Pediatric patients required more medication fills (9.11) than adults (3.86), suggesting collaborative management benefits.
Conclusions:
- Gln demonstrates favorable adherence in real-world SCD care.
- Initial insurance approval presents a barrier for pediatric patients.
- Interdisciplinary collaboration and adherence tracking are crucial for sustained Gln therapy management in SCD.
Abstract:
Glutamine (Gln) was FDA-approved in 2017 to reduce acute sickle cell disease (SCD) pain and acute chest syndrome. However, typical pediatric patients with SCD exhibit moderate adherence, measured by a medication possession ratio <80%. This study examined Gln utilization in a "real-world" clinical setting to determine factors influencing medication adherence and to characterize the impact of an interdisciplinary team approach at an institution with specialty pharmacy services. A retrospective chart review identified 40 patients prescribed Gln by sickle cell specialists over a 2-year period and met selection criteria. Gln medication possession ratio for pediatric (72%) and adult (76%) patients were higher than other SCD medications. Pediatric patients (74%) demonstrated significantly lower first-attempt insurance approval rate compared with adult patients (95%) ( P =0.0026), suggesting an initial access barrier for pediatric patients. Pediatric patients demonstrated significantly higher number of medication fills (9.11 fills) compared with adult patients (3.86 fills) ( P =0.007), which suggests interdisciplinary collaboration may facilitate sustainable management of a new therapy. The majority of pediatric (89%) and adult (90%) patients reported high satisfaction with Gln ("excellent") with minor or no side effects. Multidisciplinary health care provider collaborations and tracking medication adherence metrics can help address barriers to care for SCD patients.
