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Previous Volume 353:33-45 July 7, 2005 Number 1 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Barbui, T. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background We conducted a randomized comparison of hydroxyurea with anagrelide in the treatment of essential thrombocythemia.

Methods A total of 809 patients with essential thrombocythemia who were at high risk for vascular events received low-dose aspirin plus either anagrelide or hydroxyurea. The composite primary end point was the actuarial risk of arterial thrombosis (myocardial infarction, unstable angina, cerebrovascular accident, transient ischemic attack, or peripheral arterial thrombosis), venous thrombosis (deep-vein thrombosis, splanchnic-vein thrombosis, or pulmonary embolism), serious hemorrhage, or death from thrombotic or hemorrhagic causes.

Results After a median follow-up of 39 months, patients in the anagrelide group were significantly more likely than those in the hydroxyurea group to have reached the primary end point (odds ratio, 1.57; 95 percent confidence interval, 1.04 to 2.37; P=0.03). As compared with hydroxyurea plus aspirin, anagrelide plus aspirin was associated with increased rates of arterial thrombosis (P=0.004), serious hemorrhage (P=0.008), and transformation to myelofibrosis (P=0.01) but with a decreased rate of venous thromboembolism (P=0.006). Patients receiving anagrelide were more likely to withdraw from their assigned treatment (P<0.001). Equivalent long-term control of the platelet count was achieved in both groups.

Conclusions Hydroxyurea plus low-dose aspirin is superior to anagrelide plus low-dose aspirin for patients with essential thrombocythemia at high risk for vascular events.

Source Information

From the Department of Haematology, University of Cambridge, and Addenbrooke's National Health Service Trust, Cambridge (P.J.C., C.L.E., A.R.G.); the Departments of Haematology and Histopathology, St. Thomas Hospital, London (C.N.H., J.D.W.); the Clinical Trial Service Unit, Radcliffe Infirmary, Oxford (G.B.); Birmingham Clinical Trials Unit, University of Birmingham, Birmingham (K.W.); the Department of Haematology, City Hospital National Health Service Trust, Birmingham (D.B.); the Department of Histopathology, Royal Victoria Infirmary, Newcastle-upon-Tyne (B.S.W.); the Department of Haematology, University of Sheffield, Sheffield (J.T.R.); the Department of Haematology, Staffordshire General Hospital, Stafford (P.R.); and the Department of Haematology, Southport and Formby District General Hospital, Southport (B.E.W.) — all in the United Kingdom; and the Department of Haematology, Royal Melbourne Hospital, Melbourne, Australia (A.P.G.).

Address reprint requests to Dr. Green at the Department of Haematology, Cambridge Institute of Medical Research, Hills Rd., Cambridge CB2 2XY, United Kingdom, or at arg1000{at}cam.ac.uk.

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