In 2017, glutamine, an essential amino acid both produced in the body and found in animal and plant protein, was approved as a treatment for complications of sickle cell disease (SCD) in adults and children >5 years old. Per the U.S. Food & Drug Administration, the suggested dosage is between 10-30g/day depending on body weight. L-glutamine, the form of glutamine used in treatment, has been shown to reduce the severity of acute symptoms and the amount of hospital visits due to symptoms of SCD.
Since then, patients with SCD have demonstrated only moderate adherence to medication with L-glutamine, with a medication possession ration of less than 80%.
A recent study in the Journal of Pediatric Hematology/Oncology evaluated medication adherence in patients with SCD to determine “factors influencing medication adherence and to characterize the impact of an interdisciplinary team approach at an institution with specialty pharmacy services.”
Researchers at the University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, retrospectively reviewed the charts of 40 patients who were prescribed glutamine for symptoms of SCD over a 2-year period. Though the results were published in a pediatric journal, the study included both children and adults.
Glutamine adherence was higher than other SCD medications, with 72% adherence in the pediatric study population and 76% in the adult population. Despite the pediatric participants having lower medication possession ratio, they had significantly more prescription fills than the adults (9.11 vs 3.86 fills, P=.007).
Regarding the difference in medication usage duration, the authors stated, “Interdisciplinary collaboration may facilitate sustainable management of a new therapy.”
Despite moderate adherence in the study group, most reported they were highly satisfied with glutamine treatment and there were only minor side effects or none.
One interesting outcome was that pediatric patients had a lower insurance approval rate on first fill attempt than the adults.
“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,” The authors stated.
The authors concluded that multidisciplinary collaborations between health care providers and careful tracking of medication adherence could both help to address barriers to care in this patient population.