Magnesium for treating sickle cell disease
Than NN, Soe HHK, Palaniappan SK, Abas AB, De Franceschi L
The Cochrane database of systematic reviews · 9 citations
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Institute for Health and Care Research
- Government
- Ministry of Education, India
- Government
- Evidence Synthesis Programme
Based on 3 listed funder(s).
Publication
- Published
- 2017-04-14 · Cochrane Database Syst Rev · vol. 4 · p. CD011358
- Publisher
- Elsevier BV
- Cited
- 20 citations · more than 84% of similar papers · 1.8× the field average
- References
- 111 works
- Access
- Free to read
- Research areas
- Hemoglobinopathies and Related Disorders · Iron Metabolism and Disorders · Magnesium in Health and Disease
- Keywords
- Medicine, Population, Sickle cell trait, Quality of life (healthcare), Disease, Pediatrics, Vaso-occlusive crisis, Sickle cell anemia, Internal medicine
- MeSH
- humans, anemia, sickle cell, magnesium, magnesium sulfate, hydroxyurea, pyrrolidonecarboxylic acid, antisickling agents, pain measurement, administration, oral, injections, intravenous, parents, quality of life, adolescent, adult, middle aged, child, child, preschool, randomized controlled trials as topic
5 authors
From MY, GB, IT
- Nan Nitra ThanManipal University College Malaysia
- Htoo Htoo Kyaw SoeManipal University College Malaysia
- Senthil K PalaniappanLeicester Royal Infirmary; University Hospitals of Leicester NHS Trust
- Adinegara Lutfi AbasManipal University College Malaysia
- Lucia De FranceschiUniversity of Verona
Abstract
Background
Sickle cell disease is an autosomal recessive inherited haemoglobinopathy which causes painful vaso-occlusive crises due to sickle red blood cell dehydration. Vaso-occlusive crises are common painful events responsible for a variety of clinical complications; overall mortality is increased and life expectancy decreased compared to the general population. Experimental studies suggest that intravenous magnesium has proven to be well-tolerated in individuals hospitalised for the immediate relief of acute (sudden onset) painful crisis and has the potential to decrease the length of hospital stay. Some in vitro studies and open studies of long-term oral magnesium showed promising effect on pain relief but failed to show its efficacy. The studies show that oral magnesium therapy may prevent sickle red blood cell dehydration and prevent recurrent painful episodes. There is a need to access evidence for the impact of oral and intravenous magnesium effect on frequency of pain, length of hospital stay and quality of life.
Objectives
To evaluate the effects of short-term intravenous magnesium on the length of hospital stay and quality of life in children and adults with sickle cell disease. To determine the effects of long-term oral magnesium therapy on the frequency of painful crises and the quality of life in children and adults with sickle cell disease.
Search methods
We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 01 December 2016.Date of last search of other resources (clinical trials registries): 29 March 2017.
Selection criteria
We searched for published and unpublished randomized controlled studies of oral or intravenous magnesium compared to placebo or no magnesium.
Data collection and analysis
Authors independently assessed the study quality and extracted the data using standard Cochrane methodologies.
Main results
We included five randomized placebo-controlled studies with a total of 386 participants (aged three to 53 years). Two shorter parallel studies (n = 306) compared intravenous magnesium sulphate to placebo (normal saline) for admission to hospital due to a vaso-occlusive crisis, for which we were able to analyse data. The quality of evidence was moderate for studies presenting this comparison mainly due to limitations due to risk of bias and imprecision. Two of the three longer-term studies comparing oral magnesium pidolate to placebo had a cross-over design. The third was a parallel factorial study which compared hydroxyurea and oral magnesium to each other and to placebo over a longer period of time; we only present the comparison of oral magnesium to placebo from this study. The quality of evidence was very low with uncertainty of the estimation.The eight-hourly dose levels in the two studies of intravenous magnesium were different; one used 100 mg/kg while the second used 40 mg/kg. Only one of these studies (n = 104) reported the mean daily pain score while hospitalised (a non-significant difference between groups, moderate quality evidence). The second study (n = 202) reported a number of child- and parent-reported quality of life scores. None of the scores showed any difference between treatment groups (low quality evidence). Data from one study (n = 106) showed no difference in length of stay in hospital between groups (low quality evidence). Both studies reported on adverse events, but not defined by severity as we had planned. One study showed significantly more participants receiving intravenous magnesium experienced warmth at infusion site compared to placebo; there were no differences between groups for other adverse events (low quality evidence).Three studies (n = 80) compared oral magnesium pidolate to placebo. None of them reported data which we were able to analyse. One study (n = 24) reported on the number of painful days and stated there was no difference between two groups (low quality evidence). None of the studies reported on quality of life or length of hospital stay. Two studies (n = 68) reported there were no differences in levels of magnesium in either plasma or red blood cells (moderate quality evidence). Two studies (n = 56) reported adverse events. One reported episodes of mild diarrhoea and headache, all of which resolved without stopping treatment. The second study reported adverse events as gastrointestinal disorders, headache or migraine, upper respiratory infections and rash; which were all evenly distributed across treatment groups (moderate quality evidence).
Authors' conclusions
Moderate to low quality evidence showed neither intravenous magnesium and oral magnesium therapy has an effect on reducing painful crisis, length of hospital stay and changing quality of life in treating sickle cell disease. Therefore, no definitive conclusions can be made regarding its clinical benefit. Further randomized controlled studies, perhaps multicentre, are necessary to establish whether intravenous and oral magnesium therapies have any effect on improving the health of people with sickle cell disease.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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