Dr. Shaina Willen of UC Davis Health highlighted the significant expansion of treatment options for sickle cell disease (SCD) during her "Pediatric Year in Review" presentation at the American Thoracic Society (ATS) 2025 International Conference, while also addressing the persistent challenges in treatment access.
Evolution of Sickle Cell Disease Therapies
For nearly two decades, treatment options for sickle cell disease remained extremely limited. "Historically, since 1998 for adults and to 2017 for children, we've only had one therapy for sickle cell disease," explained Dr. Willen, who is board-certified in both Pediatric Hematology/Oncology and Pediatric Pulmonology. "The only disease-modifying therapy drug related is hydroxyurea, which works very well and is a wonderful therapy."
This therapeutic landscape has dramatically changed in recent years. Since 2017, several new options have emerged:
- Endari (L-glutamine): Approved for patients with SCD
- Crizanlizumab: Available for teenagers aged 16 and older
- Voxelotor: Though recently pulled from the market in late 2024
- Gene therapies: Two groundbreaking options received FDA approval in 2023
"Now with the two gene therapy options, disease-modifying therapies, there are a lot more choices than there used to be, particularly for children," Dr. Willen noted. "It is exciting that now we have options that we didn't have before."
Significant Barriers to Access
Despite these advances, Dr. Willen emphasized that substantial barriers prevent many patients from accessing these newer therapies:
Age Restrictions
"The lower age of FDA approval is age 12, so for younger children who have severe complications, it's still not an option," Dr. Willen explained. Studies for younger children are ongoing, with potential changes expected in the coming years.
Limited Availability
"It's also a very expensive and very involved therapy, so right now, even though we've had FDA approval for about a year and a half, access is still pretty limited to very large academic centers," she added.
Families often face extensive travel requirements to reach facilities offering these treatments. The process itself is complex, involving stem cell collection and comprehensive preparation of both patients and families.
Global Disparities
Perhaps most concerning is the global disparity in access. "The majority of patients with sickle cell still live in other countries, particularly Sub-Saharan Africa," Dr. Willen highlighted. "20 million children with sickle cell disease are living in Sub-Saharan Africa, where this treatment is not an option."
Future Outlook
When asked if sickle cell disease treatments have reached an inflection point, Dr. Willen offered a measured perspective: "I do think we're still a ways away from truly pivoting the disease, because of access and even the other therapies that I mentioned outside of gene therapy still have some tricky barriers, meaning they're not being used as universally as hydroxyurea."
Nevertheless, she maintains cautious optimism about the future. "My hope is that it's a turning point, and that now that we have other things and other mechanisms and other people interested in the disease, it will be coming to have a bigger inflection point."
"I think it's exciting, and I think having other options is an exciting time for the disease," Dr. Willen concluded, "but as far as truly changing the landscape in the lives of the majority of children, I think we're still a little ways away."
