Efficacy and Safety of Deferiprone Versus Deferasirox for Transfusion-Dependent Thalassemia with Iron Overload in Ratchaburi Hospital
Abstract
Objective: Patients with transfusion-dependent thalassemia often experience iron overload due to regular blood transfusions. Iron chelation therapy plays a crucial role in preventing iron overload. Currently, there are three types of iron chelators used in Thailand: one injectable medication, deferoxamine, and two oral medications, deferiprone and deferasirox. However, previous studies have shown inconsistent results when comparing the use of deferiprone and deferasirox in patients with transfusion-dependent thalassemia. Additionally, these studies were mainly conducted in pediatric patients. Therefore, this study aims to provide insights for selecting appropriate medication for transfusion-dependent thalassemia patients.
Methods: This retrospective cohort study collected data from patients diagnosed with transfusion-dependent thalassemia and iron overload who were treated in outpatient of internal medicine from January 1, 2015, to December 31, 2019. A total of 70 patients with transfusion-dependent thalassemia were included, consisting of 36 patients who received deferiprone and 34 patients who received deferasirox. Baseline characteristic; baseline serum ferritin levels; levels of reduction in serum ferritin at 3 months, 6 months, 1 year, and 2 years; medication side effects; causes of death; and treatment follow-up were collected. The study compared the efficacy of different types of iron chelators in the patient groups.
Results: From the basic data, it was found that there were no statistically significant differences between the groups of iron chelator medications received by the patients, except for baseline serum ferritin levels and liver function tests. Patients receiving deferasirox were able to reduce serum ferritin levels at 1 year and 2 years more significantly compared to those receiving deferiprone alone, with statistical significance. Additionally, in patients receiving deferasirox combined with deferoxamine, there was a statistically significant increase in the reduction of serum ferritin levels at 1 year and 2 years compared to those receiving deferasirox alone. However, no statistically significant differences were found in the reduction of serum ferritin levels at 3 months and 6 months between patients receiving deferasirox alone or in combination with deferoxamine, compared to those receiving deferiprone alone. Regarding medication side effects, it was found that in the group of patients receiving deferiprone alone, one patient experienced gastrointestinal symptoms at 3 months and one patient at 1 year, out of a total of 33 patients. In terms of causes of death and treatment follow-ups, no patients were found to have died from receiving either deferasirox or deferiprone.
Conclusion: Patients with transfusion-dependent thalassemia and iron overload who received deferasirox, whether alone or in combination, were able to significantly reduce serum ferritin levels at 1 year and 2 years more than those who received deferiprone alone, with statistical significance. However, there were no statistically significant differences in serum ferritin levels at 3 and 6 months between the two groups.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
