title: Phytomedicines (medicines derived from plants) for sickle cell disease.
abstract: BACKGROUND
  Sickle cell disease (SCD) is a common recessively inherited disorder of haemoglobin affecting peoples originating from sub-Saharan Africa, the Middle East and Mediterranean basin, the Indian subcontinent, the Caribbean and South America. The homozygous state (SS) is associated with complications and a reduced life expectancy. Phytomedicines (medicine derived from plants in their original state) encompass much of what the populations most affected would encounter in terms of plant-remedies from traditional healers. There has been little in the way of systematic appraisal of their benefits.
  
  
  OBJECTIVE
  To assess the benefits and risks of phytomedicines in people with SCD of all types, of any age, in any setting.
  
  
  METHODS
  We searched the Cochrane Cystic Fibrosis and Genetic Disorders group specialised register of controlled trials of haemoglobinopathies, which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. We performed an additional search of the bibliographic database of Allied and Complementary Medicine (AMED). Date of most recent search of the trials register: September 2003.
  
  
  METHODS
  All randomised or quasi-randomised trials with participants of all ages with SCD, in all settings, comparing the administration of phytomedicines, by any mode to placebo or standard treatment, including blood transfusion and hydroxyurea.
  
  
  METHODS
  Both reviewers independently assessed trial quality and extracted data from the study.
  
  
  RESULTS
  Reports of two trials were found, of which only one, including 82 participants, was eligible for inclusion in this review. This Phase IIB (pivotal) study suggests that a phytomedicine, NIPRISAN, was effective in reducing episodes of SCD crisis associated with severe pain over a six-month period. NIPRISAN did not appear to affect the risk of severe complications or the level of anaemia. No serious adverse effects were reported.
  
  
  CONCLUSIONS
  While NIPRISAN, as a phytomedicine, appeared to be safe and effective, over a six-month follow-up period of this study, in reducing crises associated with severe pain, further studies are required to assess its role in the management of people with sickle cell disease. The results of Phase III, multicentre trials are awaited.
authors.affiliation: Department of Paediatrics, Royal Berkshire and Battle NHS Trust, London Road, Reading, UK, RG1 5AN. nuno_cordeiro@yahoo.com
authors.forename: N J V
authors.initials: NJ
authors.lastname: Cordeiro
authors.forename: O
authors.initials: O
authors.lastname: Oniyangi
mesh_terms: D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D000986:Antisickling Agents / Q000627:therapeutic use*; D006801:Humans; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000986:Antisickling Agents; C445122:Niprisan; D010936:Plant Extracts