Hydroxyurea Safe for Children with Sickle Cell in African Trial
A decade-long trial at four African sites found that hydroxyurea was safe for children with sickle cell anemia and did not lead to more diagnosed infections. The medicine boosts fetal hemoglobin, which reduces red blood cell sickling, but physicians had been cautious because it can lower infection-fighting neutrophils in settings with limited care. The REACH study reported no increase in infection rates or severity, including malaria.
The REACH trial enrolled 606 children and young adults with sickle cell anemia at sites in Angola, the Democratic Republic of the Congo, Kenya, and Uganda. Participants aged 1–10 joined between 2014 and 2016 and were checked every two to three months. Treatment began at a fixed hydroxyurea dose for six months, then increased as tolerated.
Hydroxyurea encourages fetal hemoglobin production, which helps prevent red blood cells from sickling. Because the drug can reduce infection-fighting neutrophils, researchers monitored infections, including malaria. Most infections were recorded after the fact from clinical history, not routine real-time tests. Higher doses were associated with lower malaria and nonmalaria infection risks.
This finding may reassure clinicians and families in low-resource African settings, where most sickle cell anemia cases occur and infection risks are a major concern. If hydroxyurea is used more confidently, children could experience fewer sickle cell complications, though access, monitoring, and drug supply may shape real-world benefits. The results may also encourage further research into safe dosing and long-term outcomes across similar health systems.