Hydroxyurea did not raise infections in African children with sickle cell anaemia, REACH analysis finds

A cohort analysis from the NIH-funded REACH trial (Realizing Effectiveness Across Continents with Hydroxyurea), published in The Lancet Haematology and reported on 8 October 2026, addresses a long-standing worry about the sickle cell drug hydroxyurea in low-income settings.

Findings

• 606 children and young adults with sickle cell anaemia at four sites in Angola, the Democratic Republic of Congo, Kenya and Uganda.
• Treatment with hydroxyurea was not associated with more clinically diagnosed infections, including at maximum tolerated dose.
• Investigators say this offers reassurance for using hydroxyurea as standard of care where intensive medical care is limited.

Why it matters

Hydroxyurea can lower blood counts, so some clinicians have hesitated to prescribe it where monitoring and infection treatment are hard to access. Sub-Saharan Africa carries most of the world’s sickle cell burden.

Limitations

This is a cohort analysis within an open-label programme, not a placebo-controlled comparison; infection counts depend on clinical diagnosis at each site, and results may not generalise to settings without trial-level follow-up. Our summary relies on a science-news report of the paper.