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Editorial

Arginine Treatment and Sickle Cell Disease Pain—A Great STArT, but a Hard End Point

JAMA 10.1001/jama.2026.14849

August 19, 2026 at 11:00 AM EDT

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In this Editorial accompanying an Original Investigation, Shaniqua Anum, MD, and Julie Kanter, MD write that acute pain episodes in sickle cell disease remain a leading cause of emergency department visits and hospitalization, yet treatment still relies largely on opioids, nonsteroidal anti-inflammatory drugs, and intravenous fluids. In the trial of intravenous Arginine, the authors write that heterogeneity in acute pain mechanisms and trial end points may have limited detection of a vascular-targeted treatment effect.

Corresponding Author: Julie Kanter, MD, Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, 1720 Second St S, Birmingham, AL 35294 (jkanter@uabmc.edu).

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