Crizanlizumab

How it works

By binding P-selectin on activated endothelium and platelets it blocks interactions with sickled red cells, leukocytes and platelets, reducing the cell adhesion that drives vaso-occlusion.

Prescribing in practice

• Infusion-related reactions, including pain shortly after infusion, can occur; administer with appropriate monitoring and observe after dosing.
• It is given by intravenous infusion to reduce crisis frequency and may be used alongside hydroxycarbamide.
• It is not a treatment for an acute vaso-occlusive crisis already in progress.

Monitoring

Monitor for infusion-related reactions during and after administration; routine laboratory monitoring is not specifically mandated by mechanism.

Counselling the patient

• This medicine is given as a regular drip to help prevent painful crises, not to treat one that has started.
• Report any reaction during or soon after the infusion, including new or worsening pain.
• Continue any other sickle cell treatments unless advised otherwise.

Evidence & guidelines

The SUSTAIN trial showed a reduction in the frequency of vaso-occlusive crises; consult current prescribing references and commissioning guidance for eligibility.