Journal List > Korean J Hematol > v.43(2) > 1032808

Seol, Kwon, Choi, Lee, Shin, Chung, Lee, Lee, Joo, and Cho: The Efficacy and Adverse Effect of Hydroxyurea as Compared with Anagrelide in Essential Thrombocythemia

Abstract

Background:

Although the platelet count may not always correlate with the risk of thrombosis, there is evidence that a strict control of the platelet count decreases the incidence of thrombotic and hemorrhagic complications. However, it is difficult to select an appropriate platelet-lowering agent. This retrospective study was performed to assess the efficacy and adverse effect of the use of hydroxyurea and anagrelide for patients with essential thrombocythemia.

Methods:

Sixty patients with essential thrombocythemia received either hydroxyurea (n=30) or anagrelide (n=30). Early responses and adverse effects of hydroxyurea and anagrelide in the patients were retrospectively analyzed.

Results:

Treatment with anagrelide or hydroxyurea resulted in a rapid decrease of the platelet count within two weeks. The response rates after treatment with hydroxyurea and anagrelide were 83% and 77%, respectively. As compared with patients treated with hydroxyurea, patients treated with anagrelide presented with adverse effects such as headache palpitation was also frequently noticed (P=0.001). However, serious hemorrhage (n=2) and transformation to leukemia (n=1) occurred in patients treated with hydroxyurea.

Conclusion:

Both anagrelide and hydroxyurea were effective and well-tolerated agents for the reduction of the platelet count. Long-term efficacy and adverse effects of the drugs remain to be determined.

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Fig. 1
Median of platelet count, according to weeks after treatment. Platelet counts were significantly different between two groups at two and four weeks. RR, response rate; W, week.
kjh-43-83f1.tif
Fig. 2
Kaplan-Meier estimates of the event of thrombotic, hemorrhagic event and leukemic transformation.
kjh-43-83f2.tif
Table 1.
Baseline characteristics of patients
Feature Hydroxyurea Anagrelide
Female/male 16/14 18/12
Median age at entry-yr (range) 59 (32∼79) 56 (33∼79)
Platelet count (×103/uL) 1,109±289 1,319±280∗
Hemoglobin (g/L) 130±14 140±12
WBC (×103/uL) 15.7±4.5 10.5±3.7ϯ
Prior treatment
  None 21 21
  Aspirin or other antiplateletagent 8 7
  Any cytoreductive agent 1 2
Combination with aspirin orother antiplatelet agent 12 10
Thrombotic and hemorrhagicrisk factor
Previous arterial thrombosis 5 6
  Previous venousthromboembolism 2 1
  Previous peripheralvascular disease 1 0
Previous angina 6 7
Smoking 8 7
Diabetes 5 4
Hypertension 9 9
Previous hemorrhage 1 1

∗Data are Mean±standard deviation,

ϯ Statistically significant p=0.002

Table 2.
Treatment withdrawal and adverse events
  Anagrelide Hydroxyurea P-value
Adverse effect 20 7 0.001∗
  Cardiac failure 0 0 NE
  Arrhythmia 0 0 NE
  Palpitation 4 2 0.393
  Headache 15 3 0.001
  Diarrhea, nausea and vomiting 4 4 1.000
  Dizziness 2 1 0.557
  Abdominal pain 3 2 0.643
  Weakness 2 1 0.557
Withdrawal from treatment 13 12 0.795
  Lack of platelet 7 5 0.552
  control 0 2 0.154
  Leukopenia 3 2 0.643
  Serious adverse event 0 1 0.317
  Side effect Choice of patient 3 2 0.643

∗Statistically significant, P=0.001.

Table 3.
Vascular and other event
  Anagrelide Hydroxyurea P-value
Thrombotic and hemorrhagic event 11 9 0.409
Thrombotic events 7 3 0.299
  Myocardial infarction 4 1 0.165
  Unstable angina 2 1 0.557
  Stroke 1 0 0.343
  Deep vein thrombosis 0 1 0.343
  Pulmonary embolism 0 0 NE
Hemorrhagic events 4 5 0.720
  Gastrointestinal bleeding 0 1 0.343
  Intracranial bleeding 0 1 0.434
  Nasal bleeding 4 3 0.690
  Leukemic transformation 0 1 0.343
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