Inhaled Nitric Oxide Does Not Shorten Sickle Cell Crisis

Inhaled nitric oxide gas does not reduce the duration of vaso-occlusive pain crisis

WEDNESDAY, March 2 (HealthDay News) -- Among patients with sickle cell disease (SCD), the use of inhaled nitric oxide does not reduce the time to resolution of a vaso-occlusive pain crisis (VOC) compared to placebo, according to a study published in the March 2 issue of the Journal of the American Medical Association.

Mark T. Gladwin, M.D., of the University of Pittsburgh, and colleagues investigated whether inhaled nitric oxide gas shortened the duration of a painful crisis in patients with SCD. A total of 150 patients hospitalized for VOC between Oct. 5, 2004, and Dec. 22, 2008, were randomized to receive inhaled nitric oxide or inhaled nitrogen placebo for up to 72 hours. The main outcome measure was the time to resolution of the painful crisis, defined by specific criteria. Secondary outcomes included length of hospitalization, visual analog pain scale scores, cumulative opioid use, and rate of acute chest syndrome.

The researchers found that the use of inhaled nitric oxide did not have a significant effect on the length of time to resolution of the VOC compared to the placebo. There were no significant differences among the secondary outcome measures. The treatment was well tolerated without serious adverse events, and no participant had a venous methemoglobin concentration exceeding 5 percent.

"The results of this study indicate that inhaled nitric oxide, in the doses and methods of administration used in this study, does not reduce VOC severity in SCD. These results underscore the need for new agents and a sustained clinical trials apparatus for studying VOC," the authors write.

One of the study authors is listed as a co-inventor on a U.S. patent for the use of nitrite salts for cardiovascular indications. Several authors disclosed financial ties with pharmaceutical companies, including Ikaria, which partially funded this study.

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