@article{bridges_telfer_ataga_orringer_hoehner_hernandez_valdez_temple_shurin_johnson-telfair_et al._2010, 
  title={The risks and benefits of long-term use of hydroxyurea in sickle cell anemia: A 17.5 year follow-up}, 
  DOI={10.17615/y997-wd39}, 
  abstractNote={A randomized, controlled clinical trial established the efficacy and safety of short-term use of hydroxyurea in adult sickle cell anemia. To examine the risks and benefits of long-term hydroxyurea usage, patients in this trial were followed for 17.5 years during which they could start or stop hydroxyurea. The purpose of this follow-up was to search for adverse outcomes and estimate mortality. For each outcome and for mortality, exact 95% confidence intervals were calculated, or tests were conducted at α = 0.05 level (p-value <0.05 for statistical significance). Although the death rate in the overall study cohort was high (43.1%; 4.4 per 100 person-years), mortality was reduced in individuals with long-term exposure to hydroxyurea. Survival curves demonstrated a significant reduction in deaths with long-term exposure. Twenty-four percent of deaths were due to pulmonary complications; 87.1% occurred in patients who never took hydroxyurea or took it for <5 years. Stroke, organ dysfunction, infection and malignancy were similar in all groups. Our results, while no longer the product of a randomized study because of the ethical concerns of withholding an efficacious treatment, suggest that long-term use of hydroxyurea is safe and might decrease mortality.}, 
  publisher={The University of North Carolina at Chapel Hill University Libraries}, 
  author={Bridges and Telfer and Ataga and Orringer and Hoehner and Hernandez and Valdez and Temple and Shurin and Johnson-Telfair and et al.}, 
  year={2010}
  }