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Blood, 1 May 2006, Vol. 107, No. 9, pp. 3738-3744.
Prepublished online as a Blood First Edition Paper on December 13, 2005; DOI 10.1182/blood-2005-07-2948.
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RED CELLS
Randomized controlled trial of deferiprone or deferoxamine in beta-thalassemia major patients with asymptomatic myocardial siderosis
Dudley J. Pennell,
Vasili Berdoukas,
Markissia Karagiorga,
Vasili Ladis,
Antonio Piga,
Athanassios Aessopos,
Efstathios D. Gotsis,
Mark A. Tanner,
Gill C. Smith,
Mark A. Westwood,
Beatrix Wonke, and
Renzo Galanello
From the National Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton Hospital, London, United Kingdom; Aghia Sophia Children's Hospital, Athens, Greece; Aghia Sophia Children's Hospital, University of Athens, Athens, Greece; Centro Microcitemie, University of Torino, Torino, Italy; Laikon Hospital, University of Athens, Athens, Greece; Institute Euromedica-Encephalos, Athens, Greece; Whittington Hospital, London, United Kingdom; and Ospedale Regionale per le Microcitemie, Cagliari, Italy.
Most deaths in beta-thalassemia major result from cardiac complications due to iron overload. Differential effects on myocardial siderosis may exist between different chelators. A randomized controlled trial was performed in 61 patients previously maintained on subcutaneous deferoxamine. The primary end point was the change in myocardial siderosis (myocardial T2*) over 1 year in patients maintained on subcutaneous deferoxamine or those switched to oral deferiprone monotherapy. The dose of deferiprone was 92 mg/kg/d and deferoxamine was 43 mg/kg for 5.7 d/wk. Compliance was 94% ± 5.3% and 93% ± 9.7% (P = .81), respectively. The improvement in myocardial T2* was significantly greater for deferiprone than deferoxamine (27% vs 13%; P = .023). Left ventricular ejection fraction increased significantly more in the deferiprone-treated group (3.1% vs 0.3% absolute units; P = .003). The changes in liver iron level (-0.93 mg/g dry weight vs -1.54 mg/g dry weight; P = .40) and serum ferritin level (-181 µg/L vs -466 µg/L; P = .16), respectively, were not significantly different between groups. The most frequent adverse events were transient gastrointestinal symptoms for deferiprone-treated patients and local reactions at the infusion site for deferoxamine. There were no episodes of agranulocytosis. Deferiprone monotherapy was significantly more effective than deferoxamine over 1 year in improving asymptomatic myocardial siderosis in beta-thalassemia major.
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