Hydroxyurea Compared with Anagrelide in High-Risk Essential Thrombocythemia
Claire N. Harrison, M.R.C.P., M.R.C.Path., Peter J. Campbell, F.R.A.C.P., F.R.C.P.A., Georgina Buck, M.Sc., Keith Wheatley, D.Phil., Clare L. East, B.Sc., David Bareford, M.D., F.R.C.P., Bridget S. Wilkins, M.D., F.R.C.Path., Jon D. van der Walt, M.D., F.R.C.Path., John T. Reilly, F.R.C.P., F.R.C.Path., Andrew P. Grigg, F.R.A.C.P., F.R.C.P.A., Paul Revell, M.D., F.R.C.P., Barrie E. Woodcock, F.R.C.P., F.R.C.Path., Anthony R. Green, F.R.C.Path., F.Med.Sci., for the United Kingdom Medical Research Council Primary Thrombocythemia 1 Study
Background We conducted a randomized comparison of hydroxyureawith anagrelide in the treatment of essential thrombocythemia.
Methods A total of 809 patients with essential thrombocythemiawho were at high risk for vascular events received low-doseaspirin plus either anagrelide or hydroxyurea. The compositeprimary 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 thromboticor hemorrhagic causes.
Results After a median follow-up of 39 months, patients in theanagrelide group were significantly more likely than those inthe 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, anagrelideplus aspirin was associated with increased rates of arterialthrombosis (P=0.004), serious hemorrhage (P=0.008), and transformationto myelofibrosis (P=0.01) but with a decreased rate of venousthromboembolism (P=0.006). Patients receiving anagrelide weremore likely to withdraw from their assigned treatment (P<0.001).Equivalent long-term control of the platelet count was achievedin both groups.
Conclusions Hydroxyurea plus low-dose aspirin is superior toanagrelide plus low-dose aspirin for patients with essentialthrombocythemia 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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