3. Duplicative Therapy

Sickle cell disease treatment is complex and may require combination therapy. Both L-glutamine and voxelotor can be used alone or in combination with hydroxyurea [1, 4, 5]. In a phase 3 clinical trial, investigators found L-glutamine was effective in preventing vasoocclusive pain in patients with frequent episodes (greater than or equal to 2 in the prior year), regardless of hydroxyurea use; therefore, it can serve as an alternative to hydroxyurea or be used as an adjunctive therapy [4, 9]. Similarly, voxelotor may be administered with or without hydroxyurea to reduce sickle cell anemia [5, 10].