Piracetam for reducing the incidence of painful sickle cell disease crises

Sickle cell disease is one of the most common genetic disorders and affects about 250 million people (5% of the world's population). It is characterised by sickle-shaped red blood cells which may block blood vessels. This can lead to pain and damage to the major organs such as the brain, liver and spleen. Standard care is mainly supportive and in response to symptoms. Pain is controlled with drugs for pain relief and fluids to improve fluid levels. In vitro studies with piracetam have shown that it hinders the bonding of sickle haemoglobin and the bunching together of platelets. It also makes the blood less sticky and red blood cells more flexible. The authors of the review identified three trials, two of which had a cross-over design. The quality of the trials was poor. There were wide differences in the people taking part, the drug dose and the outcomes measured. Three trials are included. They provide some weak and unreliable evidence that piracetam prevents painful sickle cell crises. This lack of reliable evidence illustrates some of the doubt and lack of support for the routine use of this treatment for reducing the incidence of painful sickle cell disease crises. The review authors conclude that future research should aim to provide evidence for people to make informed decisions about whether piracetam is of use. Further randomised controlled trials should be well-designed and reported according to the 'Consolidated Standards of Reporting Trials (CONSORT)' statement.