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Faranoush M, Faranoush P, Heydari I, Foroughi‐Gilvaee MR, Azarkeivan A, Parsai Kia A, Sadighnia N, Elahinia A, Zandi A, Rezvany MR, Hashemi‐Madani N, Ziaee A, Nekouian R, Rohani F. Complications in patients with transfusion dependent thalassemia: A descriptive cross-sectional study. Health Sci Rep 2023; 6:e1624. [PMID: 37841947 PMCID: PMC10568004 DOI: 10.1002/hsr2.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023] Open
Abstract
Background and Aims One of the most common hemoglobinopathies globally related to blood transfusion and iron overload in the body is thalassemia syndrome. Increasing ferritin levels can cause severe damage to the patient's body organs. This study aims to evaluate the complications of iron overload on vital body organs in patients with transfusion-dependent beta-thalassemia. Methods This descriptive cross-sectional study was performed in Iran University of Medical Sciences Hospitals on patients with a beta-thalassemia major with frequent blood transfusions. To evaluate the effect of iron overload on vital body organs, hematologic and blood analysis, echocardiography with measurement of pulmonary artery pressure (PAP) and ejection fraction (EF) tests, bone densitometry, and audiometric tests were performed for all patients. Results Of the 1010 patients participating in this study, 497 (49%) were males, 513 were (51%) females aged 5-74 years, and the majority of participants (85%) were over 20 years old. This study demonstrated that increasing ferritin levels had no notable correlation with sex, cholesterol, low-density lipoprotein, parathyroid hormone, T4, and aspartate aminotransferase. However, elevating ferritin levels had significant correlations with increasing triglyceride, phosphorus, thyroid stimulating hormone, alkaline phosphatase, alanine transaminase, and PAP levels, age, hearing disorders, splenectomy, osteoporosis, and decreasing high-density lipoprotein, body mass index, calcium, and EF levels. Conclusion Improvement in beta-thalassemia patients' survival and quality of life can be due to multidisciplinary care in a comprehensive unit through regular follow-up and early complication detection.
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Affiliation(s)
- Mohammad Faranoush
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
- Cardio‐Oncology Research Center, Rajaie Cardiovascular Medical & Research CenterIran University of Medical SciencesTehranIran
| | - Pooya Faranoush
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Iraj Heydari
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Mohammad Reza Foroughi‐Gilvaee
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Azita Azarkeivan
- Blood Transfusion Research CenterHigh Institute for Research and Education in Transfusion MedicineTehranIran
| | - Ali Parsai Kia
- Robotics Research Laboratory, School of Mechanical EngineeringIran University of Science and TechnologyTehranIran
| | - Negin Sadighnia
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Ali Elahinia
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Afsoon Zandi
- Department of Otolaryngology, Head & Neck Surgery, Taleghani HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Reza Rezvany
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Nahid Hashemi‐Madani
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Amir Ziaee
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Reza Nekouian
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
| | - Farzaneh Rohani
- Pediatric Growth and Development Research Center, Institute of EndocrinologyIran University of Medical SciencesTehranIran
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Musallam KM, Ahmed W, Almarshoodi MO, Trad O, Al Zein N, Siddique S, Shekary N, Daboul S, Hashmi S. Establishment of the Abu Dhabi Emirate Thalassemia Longitudinal Cohort (AD-TLC): leveraging the power of observation. Ann Hematol 2023; 102:2277-2278. [PMID: 37162516 DOI: 10.1007/s00277-023-05252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, 28th Street, Mohammad Bin Zayed City, PO Box 92510, Abu Dhabi, United Arab Emirates.
| | - Wesam Ahmed
- Division of Hematology and Medical Oncology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Omar Trad
- Division of Pediatric Hematology and Oncology, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Naser Al Zein
- Division of Pediatric Hematology and Oncology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Shamyla Siddique
- Thalassemia Center, Burjeel Medical City, 28th Street, Mohammad Bin Zayed City, PO Box 92510, Abu Dhabi, United Arab Emirates
| | - Nastaran Shekary
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Sulaima Daboul
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Shahrukh Hashmi
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
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3
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Abstract
Conventional therapy for severe thalassemia includes regular red cell transfusions and iron chelation therapy to prevent and treat complications of iron overload. Iron chelation is very effective when appropriately used, but inadequate iron chelation therapy continues to contribute to preventable morbidity and mortality in transfusion-dependent thalassemia. Factors that contribute to suboptimal iron chelation include poor adherence, variable pharmacokinetics, chelator adverse effects, and difficulties with precise monitoring of response. The regular assessment of adherence, adverse effects, and iron burden with appropriate treatment adjustments is necessary to optimize patient outcomes.
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Affiliation(s)
- Janet L Kwiatkowski
- Division of Hematology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3501 Civic Center Boulevard, Clinical Hub Building, Room 13547, Philadelphia, PA 19104, USA.
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4
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Abstract
Iron chelation therapy (ICT) is essential to prevent complications of iron overload in patients with transfusion-dependent thalassemia. However, the role that adherence to ICT plays in health-related outcomes is less well known. Our objectives were to identify adherence rates of ICT, and to assess methods of measurement, predictors of adherence, and adherence-related health outcomes in the literature published between 1980 and 2020. Of 543 articles, 43 met the inclusion criteria. Studies measured ICT adherence, predictors, and/or outcomes associated with adherence. Most studies were across multiple countries in Europe and North America (n = 8/43, 18.6%), recruited in clinics (n = 39/43, 90.7%), and focused on β-thalassemia (β-thal) (n = 25/43, 58.1%). Common methods of assessing ICT adherence included patient self-report (n = 24/43, 55.8%), pill count (n = 9/43, 20.9%), prescription refill history (n = 3/43, 7.0%), provider scoring (n = 3/43, 7.0%), and combinations of methods (n = 4/43, 9.3%). Studies reported adherence either in 'categories' with different levels of adherence (n = 24) or 'quantitatively' as a percentage of doses of medication taken out of those prescribed (n = 17). Adherence levels varied (median 91.7%, range 42.0-99.97%). Studies varied in sample size and methods of adherence assessment and reporting, which prohibited meta-analysis. Due to a lack of consensus on how adherence is defined, it is difficult to compare ICT adherence reporting. Further research is needed to establish guidelines for assessing adherence and identifying suboptimal adherence. Behavioral digital interventions have the potential to optimize ICT adherence and health outcomes.
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Affiliation(s)
- Margaret Locke
- Department of Internal Medicine, Zucker School of Medicine at Hofstra/Northwell Institute, Hempstead, NY, USA
| | - Paavani S. Reddy
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sherif M. Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, IL, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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5
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Eziefula C, Shah FT, Anie KA. Promoting Adherence to Iron Chelation Treatment in Beta-Thalassemia Patients. Patient Prefer Adherence 2022; 16:1423-1437. [PMID: 35698633 PMCID: PMC9188463 DOI: 10.2147/ppa.s269352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/29/2022] [Indexed: 01/19/2023] Open
Abstract
Thalassaemia is one of the commonest inherited genetic disorders world-wide with around 25,000 births of the most severely affected transfusion dependent children annually. Patients with transfusion dependent thalassaemia require regular blood transfusions to maintain life but because of this will develop iron overload. To remove the excess iron, patients are required to take iron chelation therapy (ICT). ICT requires lifelong adherence to treatment to prevent end organ damage from developing. Many of these preventable complications make adherence to therapy more complex for patients. In this review, we focus on two commonly encountered patient scenarios and discuss how different psychological models and a relational theory can be used to understand and support adherence to treatment.
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Affiliation(s)
- Chinea Eziefula
- Camden & Islington NHS Foundation Trust, London, UK
- Psychology Services, Whittington Health NHS Trust, London, UK
| | - Farrukh T Shah
- Department of Haematology, Whittington Health NHS Trust, London, UK
- Medical Director for Transfusion, NHSBT, London, UK
- Correspondence: Farrukh T Shah, Department of Haematology, Whittington Health, Magdala Avenue, London, N19 5NF, Tel +44 0207 288 5144, Email
| | - Kofi A Anie
- London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
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Chat Chai AS, Draman N, Mohd Yusoff SS, Azman NF, Zulkifli MM, Yaacob NM, Mohamad N, Hassan R, Abdullah WZ, Zilfalil BA. Non-compliance to iron chelation therapy in patients with transfusion-dependent thalassaemia. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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7
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Chapin J, Cohen AR, Neufeld EJ, Vichinsky E, Giardina PJ, Boudreaux J, Le BC, Kenney K, Trimble S, Thompson AA. An update on the US adult thalassaemia population: a report from the CDC thalassaemia treatment centres. Br J Haematol 2021; 196:380-389. [PMID: 34775608 DOI: 10.1111/bjh.17920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Thalassaemia is caused by genetic globin defects leading to anaemia, transfusion-dependence and comorbidities. Reduced survival and systemic organ disease affect transfusion-dependent thalassaemia major and thalassaemia intermedia. Recent improvements in clinical management have reduced thalassaemia mortality. The therapeutic landscape of thalassaemia may soon include gene therapies as functional cures. An analysis of the adult US thalassaemia population has not been performed since the Thalassemia Clinical Research Network cohort study from 2000 to 2006. The Centers for Disease Control and Prevention supported US thalassaemia treatment centres (TTCs) to compile longitudinal information on individuals with thalassaemia. This dataset provided an opportunity to evaluate iron balance, chelation, comorbidities and demographics of adults with thalassaemia receiving care at TTCs. Two adult cohorts were compared: those over 40 years old (n = 75) and younger adults ages 18-39 (n = 201). The older adult cohort was characterized by higher numbers of iron-related comorbidities and transfusion-related complications. By contrast, younger adults had excess hepatic and cardiac iron and were receiving combination chelation therapy. The ethnic composition of the younger cohort was predominantly of Asian origin, reflecting the demographics of immigration. These findings demonstrate that comprehensive care and periodic surveys are needed to ensure optimal health and access to emerging therapies.
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Affiliation(s)
- John Chapin
- Division of Hematology & Medical Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Alan R Cohen
- Division of Hematology, Children's Hospital Philadelphia, Philadelphia, PA, USA
| | - Ellis J Neufeld
- Boston Children's Hospital- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elliott Vichinsky
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Patricia J Giardina
- Division of Pediatric Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jeanne Boudreaux
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
| | - Binh C Le
- Bleeding Team, Epidemiology & Surveillance Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Kenney
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Trimble
- NCIRD, Immunization Services Division, Vaccine Supply and Assurance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexis A Thompson
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Shah F, Telfer P, Velangi M, Pancham S, Wynn R, Pollard S, Chalmers E, Kell J, Carter AM, Hickey J, Paramore C, Jobanputra M, Ryan K. Routine management, healthcare resource use and patient and carer‐reported outcomes of patients with transfusion‐dependent β‐thalassaemia in the United Kingdom: A mixed methods observational study. eJHaem 2021; 2:738-749. [PMID: 35845207 PMCID: PMC9175788 DOI: 10.1002/jha2.282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/19/2023]
Abstract
Objectives We evaluated routine healthcare management, clinical status and patient‐ and carer‐reported outcomes in UK paediatric and adult patients with transfusion‐dependent β‐thalassaemia (TDT). Methods A multi‐centre, observational mixed‐methodology study evaluated 165 patients (50% male; median age 24.1 [interquartile range (IQR)] 11.8–37.2] years) from nine UK centres. Results Patients had a mean of 13.7 (standard deviation [SD] ±3.2) transfusion episodes/year (mean retrospective observation period 4.7 [±0.7] years). The median (IQR) for iron overload parameters at the last assessment during the observation period were: serum ferritin (n = 165) 1961.0 (1090.0–3003.0) μg/L (38% > 2500 μg/L); R2 liver iron (n = 119) 5.4 (2.9–11.6) mg/g (16% ≥15 mg/g); T2* cardiac iron (n = 132) 30.3 (22.0–37.1) ms (10% < 10 ms). All patients received ≥1 iron chelator during the observation period; 21% received combination therapy. Patients had a mean of 7.8 (±8.1) non‐transfusion‐related hospital attendances or admissions/year. Adult patients’ mean EQ‐5D utility score was 0.69 (±0.33; n = 94 [≥16 years]) and mean Transfusion‐dependent quality of life score was 58.6 (±18.4; n = 94 [≥18 years]). For Work Productivity and Activity impairment, mean activity impairment for patients ≥18 years (n = 88) was 48% (±32%) and for carers (n = 29) was 28% (±23%). Conclusions TDT presents significant burden on patients, carers and healthcare resources.
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Affiliation(s)
| | - Paul Telfer
- Centre for Genomics and Child Health Blizard Institute Queen Mary University of London London UK
| | | | | | - Robert Wynn
- Royal Manchester Children's Hospital Manchester UK
| | | | | | | | | | | | | | | | - Kate Ryan
- Manchester Royal Infirmary Manchester UK
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9
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Lal A, Wong T, Keel S, Pagano M, Chung J, Kamdar A, Rao L, Ikeda A, Puthenveetil G, Shah S, Yu J, Vichinsky E. The transfusion management of beta thalassemia in the United States. Transfusion 2021; 61:3027-3039. [PMID: 34453453 PMCID: PMC9292563 DOI: 10.1111/trf.16640] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 01/28/2023]
Affiliation(s)
- Ashutosh Lal
- Pediatric Hematology, University of California, San Francisco, California, USA
| | - Trisha Wong
- Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Siobán Keel
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Monica Pagano
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Jong Chung
- Pediatric Hematology/Oncology, University of California, Davis, California, USA
| | - Aditi Kamdar
- Pediatric Hematology/Oncology, Stanford University, Stanford, California, USA
| | - Latha Rao
- Pediatric Hematology/Oncology, Valley Children's Hospital, Madera, California, USA
| | - Alan Ikeda
- Pediatric Hematology/Oncology, Children's Specialty Center of Nevada, Las Vegas, Nevada, USA
| | - Geetha Puthenveetil
- Pediatric Hematology/Oncology, Children's Hospital of Orange County, Orange, California, USA
| | - Sanjay Shah
- Pediatric Hematology/Oncology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Jennifer Yu
- Pediatric Hematology/Oncology, Rady Children's Hospital, San Diego, California, USA
| | - Elliott Vichinsky
- Pediatric Hematology, University of California, San Francisco, California, USA
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10
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Theppornpitak K, Trakarnsanga B, Lauhasurayotin S, Poparn H, Chiengthong K, Sosothikul D, Techavichit P. A Study to Assess and Improve Adherence to Iron Chelation Therapy in Transfusion-Dependent Thalassemia Patients. Hemoglobin 2021; 45:171-174. [PMID: 34102943 DOI: 10.1080/03630269.2021.1934010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Transfusion-dependent thalassemia (TDT) patients require regular blood transfusions. The unavoidable consequence is iron overload. Iron chelation therapy is the mainstay of treatment, of which the favorable outcome depends mainly on adherence level. The aim of this study was to assess adherence to iron chelation therapy of TDT patients. A cross-sectional cohort of TDT patients were evaluated on their adherence to chelation therapy using the Thai version of Morisky Medication Adherence Scales (MMAS-8). A total of 70 patients (38 males, 32 females), with a median age of 10 years, were enrolled in the study. Sixteen patients (22.9%) and 54 patients (77.1%) were classified as high and medium-low adherence level groups. The raised serum ferritin value for 6 months previous to enrollment in the high adherence level group is lower than the medium-low adherence level group (276.4 vs. 413.0 ng/mL, p = 0.034, respectively). Factors impacted high adherence to iron chelation including younger age (p = 0.015) and deferasirox (DFX) administration (p = 0.025). The body weight and height in both groups were not statistically different. The most common obstacle to adherence was forgetfulness. The Thai version of MMAS-8 is a practical tool for evaluating adherence to chelation therapy in TDT patients. High adherence level of patients correlates with more controlled serum ferritin level. The younger age and once-daily dose chelation therapy are associated with better adherence.
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Affiliation(s)
- Krisada Theppornpitak
- Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Bussaba Trakarnsanga
- Pharmacy Department, King Chulalongkorn Memorial Hospital University, Bangkok, Thailand
| | - Supanun Lauhasurayotin
- Department of Pediatrics, Faculty of Medicine, Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Chulalongkorn University, Bangkok, Thailand
| | - Hansamon Poparn
- Department of Pediatrics, Faculty of Medicine, Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Chulalongkorn University, Bangkok, Thailand
| | - Kanhatai Chiengthong
- Department of Pediatrics, Faculty of Medicine, Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Chulalongkorn University, Bangkok, Thailand
| | - Darintr Sosothikul
- Department of Pediatrics, Faculty of Medicine, Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Chulalongkorn University, Bangkok, Thailand
| | - Piti Techavichit
- Department of Pediatrics, Faculty of Medicine, Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Chulalongkorn University, Bangkok, Thailand
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11
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Takpradit C, Viprakasit V, Narkbunnam N, Vathana N, Phuakpet K, Pongtanakul B, Sanpakit K, Buaboonnam J. Using of deferasirox and deferoxamine in refractory iron overload thalassemia. Pediatr Int 2021; 63:404-409. [PMID: 32856363 DOI: 10.1111/ped.14444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/18/2020] [Accepted: 08/07/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Iron overload is a major complication of transfusion-dependent thalassemia (TDT) and requires iron chelation (IC) therapy. However, a combination therapy may be required for patients responding poorly to monotherapy. METHODS Nine TDT patients previously treated with IC were enrolled; five patients were previously treated with deferasirox (DFX) twice daily. The dose of DFX was 20-40 mg/kg/day, while the dose of deferoxamine (DFO) was 18-40 mg/kg/day for 3-6 days/week. RESULTS At the 6- and 12-month time points, six and eight patients demonstrated decreased serum ferritin levels, with median reductions of 707 ng/mL (range, 1,653-5,444 ng/mL) and 1,129 ng/mL (range, 1,781-7,725 ng/mL) compared to the baseline, respectively. Eight patients also had a reduced liver iron concentration (LIC), with a median reduction of 3.9 mg/g dry wt (range, 8.3-11.1 mg/g dry wt). Of the five patients treated with DFX twice daily, four responded to combination therapy. All responsive patients could finally stop DFO after the decline in LIC. Moreover, there were no treatment-related complications. CONCLUSION The combination of DFX and DFO proved to be effective and without significant toxicities for TDT patients who had been unresponsive to standard IC therapy. Further studies with a larger cohort size and long-term follow-up are warranted to elucidate the efficacy of the combination.
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Affiliation(s)
- Chayamon Takpradit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vip Viprakasit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattee Narkbunnam
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nassawee Vathana
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kamon Phuakpet
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bunchoo Pongtanakul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kleebsabai Sanpakit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jassada Buaboonnam
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Chong CC, Redzuan AM, Sathar J, Makmor-Bakry M. Patient Perspective on Iron Chelation Therapy: Barriers and Facilitators of Medication Adherence. J Patient Exp 2021; 8:2374373521996958. [PMID: 34179377 PMCID: PMC8205330 DOI: 10.1177/2374373521996958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Nonadherence to iron chelation therapy (ICT) remains a long-standing and serious issue in thalassemia, especially in resource-constrained developing countries. Barriers and facilitators of adherence to ICT in transfusion-dependent thalassemia (TDT) adult patients in Malaysia are not completely understood. This qualitative study explored factors affecting adherence to ICT among TDT adult patients at a public tertiary hospital in Malaysia. Data were collected through 21 semistructured in-depth interviews conducted among purposively sampled patients using a pretested interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed manually using thematic analysis method and managed using Atlas.Ti software. The most frequently discussed subthemes of barriers to adherence included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors. The facilitators to adherence included having insights of their illness, prevailing sources of motivation emphasizing on strong self-efficacy, low medication burden, and having enabling environment. This study has identified barriers and facilitators that are unique to Malaysian thalassemic adults related to medication adherence. Options for future multifaceted interventions are suggested.
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Affiliation(s)
- Chia Chee Chong
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jameela Sathar
- Hematology Department, Hospital Ampang, Pandan Mewah, Ampang, Selangor, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Sidhu S, Kakkar S, Dewan P, Bansal N, Sobti PC. Adherence to Iron Chelation Therapy and Its Determinants. Int J Hematol Oncol Stem Cell Res 2021; 15:27-34. [PMID: 33613898 PMCID: PMC7885136 DOI: 10.18502/ijhoscr.v15i1.5247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Thalassemia is a chronic disease requiring lifelong treatment. The adherence to regular iron chelation therapy is important to ensure complication-free survival and good quality of life. The study aim to assess the adherence to iron chelation therapy (ICT) in patients with transfusion-dependent thalassemia (TDT), evaluate various causes of non-adherence and study the impact of non-adherence on the prevalence of complications secondary to iron overload. Materials and Methods: Patients with TDT on ICT for > 6 months were enrolled in the study. Hospital records were reviewed for demographic details, iron overload status, treatment details, and the prevalence of complications. A study questionnaire was used to collect information on adherence to ICT, knowledge of patients, and the possible reasons for non-adherence. Results: A total of 215 patients with a mean age of 15.07+7.68 years and an M: F ratio of 2.2:1 were included in the study. Non-adherence to ICT was found in 10.7% of patients. Serum ferritin levels were significantly higher in the non-adherent group (3129.8+1573.2 µg/l) than the adherent population (2013.1+1277.1 µg/l). Cardiac as well as severe liver iron overload was higher in the non-adherent patients. No correlation was found between disease knowledge and adherence to ICT. Difficulties in drug administration and many medicines to be taken daily were statistically significant reasons for non-adherence. There was no difference in the co-morbidities arising due to the iron overload in the two groups. Conclusion: Nearly 11% of patients with TDT were non-adherent to ICT. Non-adherence results in higher iron overload.
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Affiliation(s)
- Sukhmani Sidhu
- Bachelor of Medicine and Bachelor of Surgery Student, Dayanand Medical College, Ludhiana, Punjab, India
| | - Shruti Kakkar
- Department of Pediatrics, Dayanand Medical College, Ludhiana, Punjab, India
| | - Priyanka Dewan
- Department of Pediatrics, Dayanand Medical College, Ludhiana, Punjab, India
| | - Namita Bansal
- Research & Development Unit, Dayanand Medical College, Ludhiana, Punjab, India
| | - Praveen C Sobti
- Guru Teg Bahadur Sahib Charitable Hospital, Ludhiana, Punjab, India
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Hussain S, Hoodbhoy Z, Ali F, Hasan E, Alvi N, Hussain A, Ishrat K, Ur Rahman Z, Qamruddin A, Parvin A, Hasan BS. Reduction of cardiac iron overload by optimising iron chelation therapy in transfusion dependent thalassaemia using cardiac T2* MRI: a quality improvement project from Pakistan. Arch Dis Child 2020; 105:1041-1048. [PMID: 32994214 DOI: 10.1136/archdischild-2020-319203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Cardiac T2* MRI (T2*CMR), for accurate estimation of myocardial siderosis, was introduced as part of a QI collaborative to optimise chelation therapy in order to improve cardiac morbidity in transfusion dependent thalassaemia (TDT) patients. We report the impact of this QI initiative from two thalassaemia centres from this collaborative. DESIGN AND SETTING A key driver based quality initiative was implemented to improve chelation in TDT patients registered at these two centres in Karachi, Pakistan. Protocol optimisation and compliance to treatment through training, communication and feedback were used as the drivers for QI intervention. Preintervention variables (demographics, chelation history, T2*CMR, echocardiography and holters) were collected from January 2015 to December 2016) and compared with variables in the post implementation phase (January to December 2019). A standardised adverse event severity for chelators and its management was devised for safe drug therapy as well as ensuring compliance to the regimen. Preintervention and postintervention variables were compared using non-parametric test. P value<0.05 was statistically significant. RESULTS 100 patients with TDT, median age 17 (9-34) years, were included. An increase or stabilisation of T2*CMR was documented in 82% patients in the postintervention phase especially in patients with severe myocardial iron overload (5.5 vs 5.3 ms, p <0.01). Significantly fewer patients had abnormal echocardiographic findings (3.5% vs 26%, p <0.05) in the postintervention versus preintervention period. CONCLUSION This QI initiative improved the chelation therapy leading to improved cardiac status in TDT patients at the participating centres.
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Affiliation(s)
| | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
| | - Erum Hasan
- Kashif Iqbal Thalassaemia Care Centre, Karachi, Sindh, Pakistan
| | - Najveen Alvi
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
| | | | | | | | | | - Azra Parvin
- Fatimid Foundation, Karachi, Sindh, Pakistan
| | - Babar S Hasan
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
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15
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Stacy S, Sheth S, Coleman B, Cerenzia W. An assessment of the continuing medical education needs of US physicians in the management of patients with beta thalassemia. Ann Hematol 2021; 100:27-35. [PMID: 32870368 DOI: 10.1007/s00277-020-04246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/28/2020] [Indexed: 01/19/2023]
Abstract
Patients with beta thalassemia are benefitting from longer life expectancies, highlighting the importance of appropriate transition from pediatric to adult care. Data are limited regarding continuity of care and adult hematologists’ management of patients with beta thalassemia. We conducted a survey of practicing US hematologists to identify practice gaps, attitudes, and barriers to optimal patient management among US-practicing hematologists. A total of 42 responses were collected, with 19 (45%) practicing at a beta thalassemia center of excellence (CoE). Nearly 90% of CoE physicians said they had a transition protocol or plan in place versus 30% of non-CoE physicians. Most physicians said parents should remain actively involved in medical visits. Adherence was rated as the most important patient education topic during transition. The most significant barrier cited was patient reluctance to transition away from pediatric care. Physicians in CoEs as compared with non-CoE physicians reported greater knowledge of beta thalassemia and familiarity with butyrates, gene therapy, and luspatercept. Highly rated topics for beta thalassemia-focused CME activities included management of complications and clinical trial updates. These findings suggest practice gaps and barriers to optimal care in the transition from pediatric to adult care, the ongoing management of adult patients, knowledge of the disease state, and familiarity with emerging treatments. Differences CoE vs non-CoE physician responses suggest variations in knowledge, practice, and attitudes that may be helpful in tailoring CME activities to different learner audiences. The small sample size used in some sub-analyses may not be representative of all hematologists treating beta thalassemia patients.
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Akdag Y, Gulsun T, Izat N, Cetin M, Oner L, Sahin S. Characterization and comparison of deferasirox fast disintegrating tablets prepared by direct compression and lyophilization methods. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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Hagar RW. Transfusional Iron Chelation Inches Forward. Acta Haematol 2020; 142:123-124. [PMID: 31189159 DOI: 10.1159/000497431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/02/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Robert Ward Hagar
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA,
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18
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Badawy SM, Morrone K, Thompson A, Palermo TM. Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia. Cochrane Database Syst Rev 2019; 6:CD012900. [PMID: 31250923 PMCID: PMC6598413 DOI: 10.1002/14651858.cd012900.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thalassemia syndromes are inherited hemoglobin disorders that result when the synthesis of normal hemoglobin is lacking or significantly reduced. For people with thalassemia, long-term red blood cell transfusion remains the mainstay of therapy, which may lead to iron overload causing severe complications and damage in different body organs. Long-term iron chelation therapy is essential for people with thalassemia to minimize the ongoing iron-loading process. In addition, suboptimal adherence can increase adverse events associated with iron overload and result in increased morbidity, mortality, healthcare utilization and cost of care. OBJECTIVES To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including:- evaluating the effects of using computer and mobile technology interventions for medication adherence and disease management on health and behavioral outcomes;- identifying and assessing the effects of computer and mobile technology interventions specific to different age groups (children, adolescents and adults) and type of modality (e.g. cell phone, the Internet). SEARCH METHODS We searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global, Psychology and Behavioral Sciences Collection, Web of Science Science & Social Sciences Conference Proceedings Indexes, IEEE Xplore and ongoing trial databases (22 February 2018). We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register (20 June 2019). We also searched for unpublished work in the abstract book of nine major conferences in the related field. SELECTION CRITERIA Randomized controlled trials (RCT) and quasi-RCTs comparing single- or multi-component interventions versus no intervention, placebo or standard care, with adherence to iron chelation as the primary outcome were eligible for inclusion. Non-randomized studies of interventions, controlled before-after studies, and interrupted-time-series studies were also eligible for inclusion. DATA COLLECTION AND ANALYSIS Three authors independently assessed study eligibility. If we had included any studies, we would have independently assessed risk of bias and extracted data; we planned to assess the quality of the evidence using GRADE. MAIN RESULTS We did not identify any eligible studies for inclusion in the review. AUTHORS' CONCLUSIONS Due to lack of evidence, we cannot comment on the efficacy or effectiveness of computer and mobile technology intervention strategies to promote disease management and adherence to iron chelation therapy in people with thalassemia.We concluded that RCTs are needed to examine a variety of computer and mobile technology intervention strategies that may be useful for promoting disease management and increasing adherence to iron chelation therapy in individuals with thalassemia.
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Affiliation(s)
- Sherif M Badawy
- Ann & Robert H. Lurie Children’s Hospital of Chicago; Northwestern University Feinberg School of MedicinePaediatrics, Division of Hematology, Oncology and Stem Cell Transplant225 E. Chicago Avenue, Box #30ChicagoIllinoisUSAIL 60611
| | - Kerry Morrone
- Children's Hospital at MontefioreDepartment of Pediatric Hematology Oncology3415 Bainbridge AveBronxNew YorkUSANY 10467
| | - Alexis Thompson
- Ann & Robert H. Lurie Children’s Hospital of Chicago; Northwestern University Feinberg School of MedicinePaediatrics, Division of Hematology, Oncology and Stem Cell Transplant225 E. Chicago Avenue, Box #30ChicagoIllinoisUSAIL 60611
| | - Tonya M Palermo
- University of WashingtonAnesthesiology and Pain MedicineP.O. Box 5371, M/S CW‐8SeattleWashingtonUSA98145
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19
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Ho PJ, Hiwase D, Ramakrishna R, Viiala N, Solterbeck A, Traficante R, Zor E, Gervasio OL, High LM, Ross DM, Bowden DK. Cardiac and hepatic siderosis in myelodysplastic syndrome, thalassemia and diverse causes of transfusion-dependent anemia: the TIMES study. Hemasphere 2019; 3:e224. [PMID: 31723837 PMCID: PMC6746020 DOI: 10.1097/hs9.0000000000000224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/30/2019] [Accepted: 03/20/2019] [Indexed: 01/19/2023] Open
Abstract
Supplemental Digital Content is available in the text The significant morbidity and mortality associated with iron overload can be reduced by effective iron chelation. Magnetic resonance imaging (MRI) provides accurate and reproducible iron load assessment. The aim of this epidemiological study was to assess the prevalence and severity of cardiac and hepatic siderosis by MRI and to evaluate the impact of MRI on clinical management in patients with transfusion-dependent anemia and non-transfusion-dependent thalassemia (NTDT). We enrolled 243 patients with myelodysplastic syndromes (MDS), thalassemia major (TM), NTDT or other chronic anemia. Overall, 10% and 48% had cardiac and hepatic siderosis, respectively. Mean liver iron concentration (LIC) was above target range in all groups; mean myocardial T2∗ was normal. Hepatic siderosis was more prevalent than myocardial siderosis in patients with MDS, occurring in 54.4% and 4.4% of patients, respectively. As also observed in patients with NTDT or other anemia, hepatic siderosis was present in a large proportion of MDS patients who were chelation naïve (57.7%), as well as in patients receiving iron chelation therapy (ICT) (52.4%), despite a lower transfusion load compared with TM. Correlation between LIC and serum ferritin was observed across diseases; however, not all patients requiring ICT could be identified with serum ferritin alone, as serum ferritin underestimated LIC in 4.4% and overestimated LIC in 7.5% of patients. Exploratory analyses showed serum ferritin thresholds for liver siderosis detected by MRI at approximately 300 ng/mL higher in MDS than in TM. Most patients reported low–medium adherence to ICT; MRI assessment led to change in ICT in 46% of evaluable patients, including 52% of MDS patients. Accurate organ iron monitoring by MRI facilitated appropriate initiation of chelation, dose optimization and clinical decision making. Trial registration: ClinicalTrials.gov: NCT01736540.
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Affiliation(s)
- P Joy Ho
- Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | | | | | | | - Evren Zor
- Novartis Pharmaceuticals, Sydney, Australia
| | | | | | - David M Ross
- Flinders University and Medical Centre, Adelaide, Australia
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20
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Binding A, Ward R, Tomlinson G, Kuo KHM. Deferiprone exerts a dose-dependent reduction of liver iron in adults with iron overload. Eur J Haematol 2019; 103:80-87. [PMID: 31066943 DOI: 10.1111/ejh.13244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE While doses of deferiprone up to 75 mg/kg/d have been demonstrated to be effective in cardiac iron removal, their efficacy in the reduction of liver iron has been equivocal. The aim of this study was to evaluate the effect of deferiprone dose on liver iron concentrations in adult iron overload patients. METHODS A single-centered, retrospective, cohort observational study was conducted involving 71 patients exposed to deferiprone doses up to 113 mg/kg/d between January 2009 and June 2015 for a median of 33 months. RESULTS At the end of the study period, liver iron measured by R2 MRI was reduced by a mean 1.7 mg/g dw. A dose effect was observed, with incremental reductions of 2.8 mg/g dw in end of study LIC for every 10 mg/kg/d higher dose of deferiprone (P < 0.001). A dose effect was also observed in end of study ferritin and cardiac iron concentration measured by T2* MRI (P < 0.0001 and P = 0.048, respectively). No associations between adverse effects and deferiprone dose were observed, but there was a trend toward higher rates of agranulocytosis at higher doses and two of three hereditary hemochromatosis patients developed this complication. CONCLUSION The present study failed to demonstrate that the use of deferiprone at >90 mg/kg/d was associated with increased risk of agranulocytosis or neutropenia, but did demonstrate more effective liver iron control in iron overload patients.
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Affiliation(s)
- Andrew Binding
- Division of Hematology, University of Toronto, Toronto, Ontario, Canada.,Divison of Medical Oncology & Hematology, University Health Network, Toronto, Ontario, Canada
| | - Richard Ward
- Division of Hematology, University of Toronto, Toronto, Ontario, Canada.,Divison of Medical Oncology & Hematology, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kevin H M Kuo
- Division of Hematology, University of Toronto, Toronto, Ontario, Canada.,Divison of Medical Oncology & Hematology, University Health Network, Toronto, Ontario, Canada
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21
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Cheng WY, Said Q, Hao Y, Xiao Y, Vekeman F, Bobbili P, Duh MS, Nandal S, Blinder M. Adherence to iron chelation therapy in patients who switched from deferasirox dispersible tablets to deferasirox film-coated tablets. Curr Med Res Opin 2018; 34:1959-1966. [PMID: 29701080 DOI: 10.1080/03007995.2018.1470500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare real-world adherence to and persistence with deferasirox film-coated tablets (DFX-FCT) and deferasirox dispersible tablets (DFX-DT) among patients who switched from DFX-DT to DFX-FCT, overall and by disease type (sickle cell disease [SCD], thalassemia, and myelodysplastic syndrome [MDS]). METHODS Patients were ≥2 years old and had ≥2 DFX-FCT claims over the study period and ≥2 DFX-DT claims before the index date (first DFX-FCT claim). The DFX-DT period was defined from the first DFX-DT claim to the index date; the DFX-FCT period was defined from the index date to the end of the study period. Adherence was measured as medication possession ratio (MPR) and proportion of days covered (PDC). Persistence was defined as continuous medication use without a gap ≥30 or 60 days between refills. Comparisons were conducted using paired-sample Wilcoxon sign-rank and McNemar's tests. RESULTS In total, 606 patients were selected (SCD: 348; thalassemia: 107; MDS: 106; other: 45). Adherence and persistence in the DFX-FCT vs DFX-DT period was significantly higher across all measures: mean MPR was 0.80 vs 0.76 (p < .001); 60.9% vs 54.3% of patients had MPR ≥ 0.8 (p = .009); mean 3-month PDC was 0.83 vs 0.71 (p < .001); 64.2% vs 45.4% of patients had 3-month PDC ≥ 0.8 (p < .001); 87.2% vs 63.4% of patients had 3-month persistence with no gap ≥30 days and 96.1% vs 79.9% with no gap ≥60 days (p < .001). Adherence and persistence improved after switching across all diseases, particularly MDS. CONCLUSIONS Adherence and persistence improved significantly after switching from DFX-DT to DFX-FCT for all diseases, but especially MDS.
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Affiliation(s)
| | - Qayyim Said
- b Novartis Pharmaceutical Corporation , East Hanover , NJ , USA
| | - Yanni Hao
- b Novartis Pharmaceutical Corporation , East Hanover , NJ , USA
| | | | | | | | | | - Savita Nandal
- b Novartis Pharmaceutical Corporation , East Hanover , NJ , USA
| | - Morey Blinder
- c Washington University School of Medicine , St. Louis , MO , USA
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22
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Kattamis A, Aydinok Y, Taher A. Optimising management of deferasirox therapy for patients with transfusion-dependent thalassaemia and lower-risk myelodysplastic syndromes. Eur J Haematol 2018; 101:272-282. [PMID: 29904950 DOI: 10.1111/ejh.13111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 01/19/2023]
Abstract
Effective iron chelation therapy is an important part of treatment in patients with transfusion-dependent thalassaemia and lower-risk myelodysplastic syndromes (MDS). Key strategies for optimising iron chelation therapy include ensuring good adherence and preventing and managing adverse events (AEs). Good adherence to iron chelation therapy with deferoxamine and deferasirox has been linked to improved survival and/or reductions in complications related to iron overload; however, maintaining good adherence to iron chelators can be challenging. Patients with transfusion-dependent thalassaemia or lower-risk MDS showed better adherence to the deferasirox film-coated tablet (FCT) formulation than to the deferasirox dispersible tablet formulation in the ECLIPSE trial, reflecting in part the improved palatability and convenience of deferasirox FCT. As well as affecting adherence, AEs may lead to dose reduction, interruption or discontinuation, resulting in suboptimal iron chelation therapy. Preventing and successfully managing AEs may help limit their impact on adherence, and following dosage and administration recommendations for iron chelators such as deferasirox may help minimise AEs and optimise treatment in patients with transfusion-dependent thalassaemia and lower-risk MDS.
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Affiliation(s)
- Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Yesim Aydinok
- Department of Pediatric Hematology, Ege University Hospital, Izmir, Turkey
| | - Ali Taher
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
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23
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Shah F, Kaltsounis G. Adherence to Treatment: Doctor vs Patient Perspective. Thalassemia Reports 2018. [DOI: 10.4081/thal.2018.7484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
It has been demonstrated over time that patients with haemoglobinopathies who exhibit a high level of compliance to proper therapy benefit not only from higher life expectancy but also from significantly better quality of life. The treatment of thalassaemia consists of blood transfusions and iron chelation therapy. Managing any complications due to iron overload, performing all necessary clinical and laboratory examinations and dealing effectively with psychological issues are also very important. Blood transfusion scheme must be designed by the treating physician according to the patient’s clinical needs. Chelation therapy should be aimed at selecting the right medication and the right dose. Examinations should be as organized as possible, and the management of complications depends significantly on cooperation with experienced specialists in each respective field. Ultimately, effectiveness of treatment and patient’s psychological well-being (acceptance of the disease and positive attitude) are the most decisive factors, as they seem to be connected to adherence through a mechanism of positive feedback. Hence, professional psychological support should be part of multidisciplinary care. Difference of point of view between doctor and patient can often be the reason behind misinterpretations or misunderstandings.
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Abstract
β-Thalassemia major (β-TM) is a life-long genetic hemoglobin (Hb) disorder requiring intensive treatment regimens, including frequent blood transfusions and daily chelation therapy. Understanding psychosocial correlates of chelation adherence is important for developing interventions to improve adherence. This study investigated within-participant correlates of oral chelation adherence on a daily (episodic) basis. Thirty-seven adult participants with β-TM were recruited from clinics at two hospitals (22 males, 9 females, mean age 34.5 years, range 19-54 years). A structured interview was used to assess behavioral and psychological situational variables related to an adherent and a nonadherent episode for each participant. Positive outcome expectancies and higher self-efficacy were both significantly associated with adherent episodes. Behavioral variables, including difficulty in accessing medication, location, and whether alone or with others, were also associated with nonadherent episodes. Findings suggested that situational psychological factors are important for chelation adherence. Adherence interventions should consider focusing on potentially modifiable situational variables (psychological and behavioral).
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Affiliation(s)
- Jane Vosper
- a Department of Clinical Psychology , Royal Holloway University of London , Egham , UK
| | - Michael Evangeli
- a Department of Clinical Psychology , Royal Holloway University of London , Egham , UK
| | - John B Porter
- b Clinical Haematology, Joint Red Cell Unit , University College London Hospitals , London , UK
| | - Farrukh Shah
- c Clinical Haematology, Joint Red Cell Unit, Department of Haematology , The Whittington Hospital , London , UK
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25
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Abstract
Introduction of MRI techniques for identifying and monitoring tissue iron overload and the current understanding of iron homeostasis in transfusion-dependent (TDT) and non-transfusion-dependent thalassemia have allowed for a more robust administration of iron chelation therapies. The development of safe and efficient oral iron chelators and the insights gained from large-scale prospective studies using these agents have improved iron overload management. A significant reduction in iron toxicity-induced morbidity and mortality and improvements in quality of life were observed in TDT. The appropriate management of tissue-specific iron loading in TDT has been portrayed using evidence-based data obtained from investigational studies.
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Affiliation(s)
- Yesim Aydinok
- Department of Pediatric Hematology and Oncology, Ege University Children's Hospital, Bornova, Izmir 35100, Turkey.
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Badawy SM, Morrone K, Thompson A, Palermo TM. Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia. Cochrane Database Syst Rev 2017. [PMID: 29861660 PMCID: PMC5978731 DOI: 10.1002/14651858.cd012900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including: evaluating the effects of using computer and mobile technology interventions for medication adherence and disease management on health and behavioural outcomes;identifying and assessing the effects of computer and mobile technology interventions specific to different age groups (children, adolescents and adults) and type of modality (e.g. cell phone, the Internet).
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Affiliation(s)
- Sherif M Badawy
- Ann & Robert H. Lurie Children’s Hospital of Chicago; Northwestern University Feinberg School of MedicinePaediatrics, Division of Hematology, Oncology and Stem Cell Transplant225 E. Chicago Avenue, Box #30ChicagoUSAIL 60611
| | - Kerry Morrone
- Children's Hospital at MontefioreDepartment of Pediatric Hematology Oncology3415 Bainbridge AveBronxUSANY 10467
| | - Alexis Thompson
- Ann & Robert H. Lurie Children’s Hospital of Chicago; Northwestern University Feinberg School of MedicinePaediatrics, Division of Hematology, Oncology and Stem Cell Transplant225 E. Chicago Avenue, Box #30ChicagoUSAIL 60611
| | - Tonya M Palermo
- University of WashingtonAnesthesiology and Pain MedicineP.O. Box 5371, M/S CW‐8SeattleUSA98145
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27
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Badawy SM, Morrone K, Thompson A, Palermo TM. Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia. Cochrane Database Syst Rev 2017; 2017:CD012900. [PMID: 29861660 PMCID: PMC5978731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including: evaluating the effects of using computer and mobile technology interventions for medication adherence and disease management on health and behavioural outcomes;identifying and assessing the effects of computer and mobile technology interventions specific to different age groups (children, adolescents and adults) and type of modality (e.g. cell phone, the Internet).
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Affiliation(s)
- Sherif M Badawy
- Paediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kerry Morrone
- Department of Pediatric Hematology Oncology, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Alexis Thompson
- Paediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tonya M Palermo
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Abstract
BACKGROUND Thalassaemia is a hereditary anaemia due to ineffective erythropoiesis. In particular, people with thalassaemia major develop secondary iron overload resulting from regular red blood cell transfusions. Iron chelation therapy is needed to prevent long-term complications.Both deferoxamine and deferiprone are effective; however, a review of the effectiveness and safety of the newer oral chelator deferasirox in people with thalassaemia is needed. OBJECTIVES To assess the effectiveness and safety of oral deferasirox in people with thalassaemia and iron overload. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 12 August 2016.We also searched MEDLINE, Embase, the Cochrane Library, Biosis Previews, Web of Science Core Collection and three trial registries: ClinicalTrials.gov; the WHO International Clinical Trials Registry Platform; and the Internet Portal of the German Clinical Trials Register: 06 and 07 August 2015. SELECTION CRITERIA Randomised controlled studies comparing deferasirox with no therapy or placebo or with another iron-chelating treatment. DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. MAIN RESULTS Sixteen studies involving 1807 randomised participants (range 23 to 586 participants) were included. Twelve two-arm studies compared deferasirox to placebo (two studies) or deferoxamine (seven studies) or deferiprone (one study) or the combination of deferasirox and deferoxamine to deferoxamine alone (one study). One study compared the combination of deferasirox and deferiprone to deferiprone in combination with deferoxamine. Three three-arm studies compared deferasirox to deferoxamine and deferiprone (two studies) or the combination of deferasirox and deferiprone to deferiprone and deferasirox monotherapy respectively (one study). One four-arm study compared two different doses of deferasirox to matching placebo groups.The two studies (a pharmacokinetic and a dose-escalation study) comparing deferasirox to placebo (n = 47) in people with transfusion-dependent thalassaemia showed that deferasirox leads to net iron excretion. In these studies, safety was acceptable and further investigation in phase II and phase III studies was warranted.Nine studies (1251 participants) provided data for deferasirox versus standard treatment with deferoxamine. Data suggest that a similar efficacy can be achieved depending on the ratio of doses of deferoxamine and deferasirox being compared. In the phase III study, similar or superior efficacy for the intermediate markers ferritin and liver iron concentration (LIC) could only be achieved in the highly iron-overloaded subgroup at a mean ratio of 1 mg of deferasirox to 1.8 mg of deferoxamine corresponding to a mean dose of 28.2 mg per day and 51.6 mg per day respectively. The pooled effects across the different dosing ratios are: serum ferritin, mean difference (MD) 454.42 ng/mL (95% confidence interval (CI) 337.13 to 571.71) (moderate quality evidence); LIC evaluated by biopsy or SQUID, MD 2.37 mg Fe/g dry weight (95% CI 1.68 to 3.07) (moderate quality evidence) and responder analysis, LIC 1 to < 7 mg Fe/g dry weight, risk ratio (RR) 0.80 (95% CI 0.69 to 0.92) (moderate quality evidence). The substantial heterogeneity observed could be explained by the different dosing ratios. Data on mortality (low quality evidence) and on safety at the presumably required doses for effective chelation therapy are limited. Patient satisfaction was better with deferasirox among those who had previously received deferoxamine treatment, RR 2.20 (95% CI 1.89 to 2.57) (moderate quality evidence). The rate of discontinuations was similar for both drugs (low quality evidence).For the remaining comparisons in people with transfusion-dependent thalassaemia, the quality of the evidence for outcomes assessed was low to very low, mainly due to the very small number of participants included. Four studies (205 participants) compared deferasirox to deferiprone; one of which (41 participants) revealed a higher number of participants experiencing arthralgia in the deferiprone group, but due to the large number of different types of adverse events reported and compared this result is uncertain. One study (96 participants) compared deferasirox combined with deferiprone to deferiprone with deferoxamine. Participants treated with the combination of the oral iron chelators had a higher adherence compared to those treated with deferiprone and deferoxamine, but no participants discontinued the study. In the comparisons of deferasirox versus combined deferasirox and deferiprone and that of deferiprone versus combined deferasirox and deferiprone (one study, 40 participants), and deferasirox and deferoxamine versus deferoxamine alone (one study, 94 participants), only a few patient-relevant outcomes were reported and no significant differences were observed.One study (166 participants) included people with non-transfusion dependent thalassaemia and compared two different doses of deferasirox to placebo. Deferasirox treatment reduced serum ferritin, MD -306.74 ng/mL (95% CI -398.23 to -215.24) (moderate quality evidence) and LIC, MD -3.27 mg Fe/g dry weight (95% CI -4.44 to -2.09) (moderate quality evidence), while the number of participants experiencing adverse events and rate of discontinuations (low quality evidence) was similar in both groups. No participant died, but data on mortality were limited due to a follow-up period of only one year (moderate quality evidence). AUTHORS' CONCLUSIONS Deferasirox offers an important treatment option for people with thalassaemia and secondary iron overload. Based on the available data, deferasirox does not seem to be superior to deferoxamine at the usually recommended ratio of 1 mg of deferasirox to 2 mg of deferoxamine. However, similar efficacy seems to be achievable depending on the dose and ratio of deferasirox compared to deferoxamine. Whether this will result in similar efficacy and will translate to similar benefits in the long term, as has been shown for deferoxamine, needs to be confirmed. Data from randomised controlled trials on rare toxicities and long-term safety are still limited. However, after a detailed discussion of the potential benefits and risks, deferasirox could be offered as the first-line option to individuals who show a strong preference for deferasirox, and may be a reasonable treatment option for people showing an intolerance or poor adherence to deferoxamine.
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Affiliation(s)
- Claudia Bollig
- Medical Center – Univ. of Freiburg, Faculty of Medicine, Univ. of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | | | - Gerta Rücker
- Faculty of Medicine and Medical Center – University of FreiburgInstitute for Medical Biometry and StatisticsStefan‐Meier‐Str. 26FreiburgGermany79104
| | - Roman Allert
- University Hospital Frankfurt, Goethe UniversityDepartment of Obstetrics and GynaecologyFrankfurtGermany
| | - Edith Motschall
- Medical Center ‐ University of Freiburg, Faculty of Medicine, University of FreiburgCenter for Medical Biometry and Medical InformaticsStefan‐Meier‐Str. 26FreiburgGermany79104
| | - Charlotte M Niemeyer
- University Medical Center FreiburgPediatric Hematology & Oncology, Center for Pediatrics & Adolescent MedicineMathildenstrasse 1FreiburgGermany79106
| | - Dirk Bassler
- University Hospital Zurich and University of ZurichDepartment of NeonatologyFrauenklinikstrasse 10ZurichSwitzerland
| | - Joerg J Meerpohl
- Medical Center – Univ. of Freiburg, Faculty of Medicine, Univ. of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
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Affiliation(s)
- Ami Belmont
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Janet L. Kwiatkowski
- Children’s Hospital of Philadelphia, Division of Hematology and Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Philadelphia, PA, USA
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Shah J, McKiernan P. Optimizing Communication and Adherence to Iron Chelation Therapy From Diagnosis to Treatment in Patients With Myelodysplastic Syndromes. J Adv Pract Oncol 2016; 7:707-717. [PMID: 29670807 PMCID: PMC5902151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Myelodysplastic syndromes (MDS), a heterogeneous group of blood diseases, are usually diagnosed in older individuals, with a median age at diagnosis of more than 70 years. Anemia is a common symptom in patients with MDS and may require frequent red blood cell transfusions, which can lead to iron overload. Iron chelation therapy is recommended to decrease iron concentrations in tissue and minimize organ dysfunction. However, the currently available iron chelation therapies are associated with side effects, financial constraints, and dosing issues, which may affect patient adherence. Moreover, many patients with MDS lack an understanding of the disease and their prognosis and treatments. This review can be used in the advanced practice setting to discuss the importance of communicating with patients about MDS from the time of diagnosis and will explore strategies to enhance adherence to iron chelation therapy. An individualized approach that weighs the risks and benefits of treatment for older patients with MDS will allow advanced practitioners to set expectations while developing adherence strategies to optimize outcomes. This approach provides a platform for advanced practitioners to communicate with patients to ensure they understand the natural history of MDS, their individual prognoses, and the goals of both active treatment and supportive care.
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Affiliation(s)
- Jayshree Shah
- Hackensack University Medical Center, Hackensack, New Jersey
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Senol SP, Tiftik EN, Unal S, Akdeniz A, Tasdelen B, Tunctan B. Quality of life, clinical effectiveness, and satisfaction in patients with beta thalassemia major and sickle cell anemia receiving deferasirox chelation therapy. J Basic Clin Pharm 2016; 7:49-59. [PMID: 27057126 PMCID: PMC4804405 DOI: 10.4103/0976-0105.177706] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives: There is a need to remove excess iron with iron chelation therapy (ICT) to avoid the serious clinical sequelae associated with iron overload in patients with beta thalassemia major (BTM) and sickle cell anemia (SCA). Due to the effects of the diseases and their treatments, ICT is still a major reason for unsatisfactory compliance. The aim of this single-center observational study was to evaluate the quality of life, clinical effectiveness, and satisfaction in pediatric and adult patients with BTM and SCA receiving deferasirox (DFX) chelation therapy. Methods: In this study, 37 pediatric and 35 adult patients with BTM or SCA receiving DFX for at least 6 months participated. Upon receipt of Informed Consent Form, Case Report Form, Demographic Data Collection Form, Child Health Questionnaire-Parent Form, Life Quality Survey Short Form-36, and ICT Satisfaction Survey were used to obtain data for the effectiveness of ICT and parameters that may affect compliance to treatment and life quality of the participants. Results: As a main index for the effectiveness of DFX chelation therapy, serum ferritin levels were higher than the normal values in the patients receiving DFX. The increased ferritin levels were also associated with hematological and biochemical abnormalities. Our findings regarding quality of life and satisfaction with DFX chelation therapy indicated that the patients with BTM or SCA had lower scores. Overall, problems with treatment regimen and side effects appeared to be common causes of poor compliance to DFX chelation therapy. Conclusions: Our findings suggest that health care providers should be aware of the importance of monitoring iron load with timely initiation of DFX chelation therapy and ongoing adjustments to chelation regimens and/or transfusion methods to decrease hospitalizations and improve compliance to ICT of the patients with BTM and SCA.
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Affiliation(s)
- Sefika Pinar Senol
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Eyup Naci Tiftik
- Department of Internal Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Selma Unal
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Aydan Akdeniz
- Department of Internal Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Bahar Tasdelen
- Department of Biostatistics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Bahar Tunctan
- Department of Pharmacology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
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Almahmoud SY, Coifman KG, Ross GS, Kleinert D, Giardina P. Evidence for multidimensional resilience in adult patients with transfusion-dependent thalassemias: Is it more common than we think? Transfus Med 2016; 26:186-94. [PMID: 27018402 DOI: 10.1111/tme.12296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/17/2016] [Accepted: 02/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Life expectancy of patients with transfusion-dependent thalassemias has increased with the development of improved treatment over the last few decades. However, β-thalassemia disorder still has considerable lifetime treatment demands and heightened risk of frequent complications due to transfusion-transmitted infections and iron overload, which may affect thalassemic patients' functioning in different domains. OBJECTIVES The vast majority of published studies on thalassemic patients have focused on children and adolescent functioning, and little research has examined adults. Hence, the current study was planned to examine the functioning and resilience of adult thalassemic patients in a comprehensive way. METHODS We examined multidimensional resilience and functioning across different domains (psychological adjustment, treatment adherence, social functioning and occupational functioning). We also examined demographic and medical variables that may relate to resilience and functioning. Participants were adult patients [n = 38; age M = 31·63, standard deviation (SD) = 7·72; 72% female] with transfusion-dependent thalassemia in treatment in a hospital in the northeastern United States. RESULTS The results suggest that most adult thalassemic patients tend to be resilient, demonstrating good functioning in four main domains: psychological adjustment, treatment adherence, social functioning and occupational functioning. CONCLUSION Despite the considerable demands of their illness, adult thalassemic patients appeared to be adapting well, demonstrating evidence of multidimensional resilience.
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Affiliation(s)
- S Y Almahmoud
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - K G Coifman
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - G S Ross
- Department of Psychiatry, Weill/Cornell Medical Center, New York, New York, USA
| | - D Kleinert
- Department of Psychiatry, Weill/Cornell Medical Center, New York, New York, USA
| | - P Giardina
- Department of Psychiatry, Weill/Cornell Medical Center, New York, New York, USA
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Escudero-Vilaplana V, Garcia-Gonzalez X, Osorio-Prendes S, Romero-Jimenez RM, Sanjurjo-Saez M. Impact of medication adherence on the effectiveness of deferasirox for the treatment of transfusional iron overload in myelodysplastic syndrome. J Clin Pharm Ther 2016; 41:59-63. [PMID: 26778738 DOI: 10.1111/jcpt.12348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/07/2015] [Indexed: 01/19/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Regular blood transfusions in the management of myelodysplastic syndrome (MDS) often lead to iron overload. The main objective of this study was to evaluate the impact of medication adherence on the effectiveness of deferasirox for the treatment of transfusional iron overload in patients with MDS. Secondary objectives were to describe treatment effectiveness and safety in daily clinical practice. METHODS A longitudinal, retrospective, observational study was carried out in a university hospital. The inclusion criteria were age over 18 years, MDS diagnosis and treatment with deferasirox for transfusion-dependent iron overload during the period of study (from January 2011 to April 2015). Treatment effectiveness was estimated by serum ferritin (SF), and adherence was measured by medication possession ratio (MPR). Clinically relevant analytical alterations during the treatment and reasons for treatment discontinuation were also assessed. RESULTS Thirty-five patients were included in the study. Median SF at baseline was 1636 μg/L, and it decreased to 1399 μg/L during follow-up. The median adherence rate was 92%, although only 54·8% of the patients maintained deferasirox adherence ≥90% during the whole duration of treatment. Adherence rate was inversely correlated to SF (r = -0·288, P = 0·004). The median (p25, p75) duration of treatment was 11 (3·0, 37·8) months. The most common reasons for treatment discontinuation were renal toxicity (35%) and patient's death (25%). WHAT IS NEW AND CONCLUSION Deferasirox's effectiveness, measured by the decrease in SF, was significantly better in adherent patients. The most frequent reason for treatment discontinuation was renal toxicity. Developing strategies to improve deferasirox treatment adherence and monitoring renal function in those patients should be key points in pharmaceutical care.
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Affiliation(s)
- V Escudero-Vilaplana
- Pharmacy Department, Gregorio Marañón University General Hospital, Madrid, Spain
| | - X Garcia-Gonzalez
- Pharmacy Department, Gregorio Marañón University General Hospital, Madrid, Spain
| | - S Osorio-Prendes
- Hematology Department, Gregorio Marañón University General Hospital, Madrid, Spain
| | - R M Romero-Jimenez
- Pharmacy Department, Gregorio Marañón University General Hospital, Madrid, Spain
| | - M Sanjurjo-Saez
- Pharmacy Department, Gregorio Marañón University General Hospital, Madrid, Spain
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Pangjit K, Banjerdpongchai R, Phisalaphong C, Fucharoen S, Xie YY, Lu ZD, Hider RC, Srichairatanakool S. Characterisation of a novel oral iron chelator: 1-(N-Acetyl-6-Aminohexyl)-3-Hydroxy-2-Methylpyridin-4-one. ACTA ACUST UNITED AC 2015; 67:703-13. [PMID: 25627251 DOI: 10.1111/jphp.12373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 11/02/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Desferrioxamine (DFO), deferiprone (DFP) and deferasirox (DFX) are iron chelators currently in clinical use for the treatment of iron overload. Due to difficulties with administration and associated side effects with these three molecules, the search continues for an efficient nontoxic orally active iron chelator. This communication describes the properties of one such candidate, 1-(N-acetyl-6-aminohexyl)-3-hydroxy-2-methylpyridin-4-one (CM1). METHODS Physicochemical characterisation techniques, including partition coefficient, pKa values and logK values for iron(III). Iron scavenging assays, from iron citrate, nontransferrin bound iron and iron-loaded rats. Cytotoxicity studies using white cells, hepatocytes and cardiomyocytes. KEY FINDINGS CM1 possesses high affinity and selectivity for iron(III) and a suitable partition coefficient to permeate membranes. CM1 forms a neutral 3 : 1 iron(III) complex under physiological conditions and so, it is predicted to be capable of entry into mammalian cells to scavenge excess intracellular iron and to efflux from cells as the neutral 3 : 1 complex. CM1 is demonstrated to be orally active and to possess a higher efficacy than DFP in rats. CM1 displays no toxicity to a range of cell types. CONCLUSION The above promising studies will be extended to monitor the pharmacokinetics and metabolism of CM1. CM1 is an excellent candidate for phase 1 clinical trials.
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Affiliation(s)
- Kanjana Pangjit
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; College of Medicine and Public Health, Ubon Ratchathani University, Chiang Mai, Thailand
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Al-Kloub MI, A Bed MA, Al Khawaldeh OA, Al Tawarah YM, Froelicher ES. Predictors of non-adherence to follow-up visits and deferasirox chelation therapy among jordanian adolescents with Thalassemia major. Pediatr Hematol Oncol 2014; 31:624-37. [PMID: 25116329 DOI: 10.3109/08880018.2014.939792] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Poor adherence to treatment can have negative effects on outcomes and heath care cost. However, little is known about the factors that impact adherence to deferasirox chelation therapy. The aims of this study were to identify rates and predictors of non-adherence to medical regimen among thalassemia major adolescents on deferasirox oral chelation therapy by using subjective (self-reporting) and objective (serum ferritin and follow-up visits) measures. Convenient samples of 164 adolescents, aged 12-19 years were recruited from three National Thalassemia Centers in Jordan. Patients were interviewed using a four-section questionnaire and the medical records were checked. Results indicated that rate of adherence according to self-report was (73%); while to follow-up medical appointments and serum ferritin level rates was 57% and 47%, respectively. One-third of participant adolescents (n = 52) were psychologically impaired. Multivariate analysis showed that factors affecting adolescent non-adherence to deferasirox chelation therapy is different from that affecting adherence to follow-up visits. In general, adolescents more than 16 years old, presence of sibling with thalassemia, lack of parental monitoring, lower family income, decrease frequency of blood transfusion, and psychological impairment were found significant predictors of non-adherence among adolescents. Disease knowledge was not associated with adherence status of the adolescents. Clinician should be aware of high prevalence of low adherence to chelation therapy during adolescent years. Nurses need to regularly assess, monitor, and promote adherence behavior that might impact patients' outcomes.
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Affiliation(s)
- Manal Ibrahim Al-Kloub
- 1Department of Maternal, Child and Family Health, The Hashemite University, Zarqa, Jordan
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Abstract
BACKGROUND Although research has demonstrated the detrimental effects of excessive negative affect on treatment adherence and morbidity in chronic illness, rarely have researchers investigated the benefits of awareness of negative emotional experiences during treatment. PURPOSE In this investigation, we examined the association of negative affect differentiation (the ability to report negative emotional experiences as separate and distinct from each other,) to treatment adherence in adult patients with the congenital blood disorder thalassemia. METHOD Negative affect differentiation was assessed during a 12-16-week treatment-based diary and adherence was operationalized as attendance at routine screenings over 12 months. Participants were adult patients (n = 32; age M = 31.63, SD = 7.72; 72 % female) with transfusion-dependent thalassemia in treatment in a large metropolitan hospital in the Northeastern USA. RESULTS The results indicate that negative affect differentiation is significantly associated with greater adherence to treatment, even when controlling for disease burden and level of psychological distress. CONCLUSION Although preliminary, this investigation suggests that differentiated processing of negative emotional experiences during illness can lead to adaptive treatment-related behavior. As such, it may present a new avenue for research and intervention targeting the improvement of adherence during treatment for chronic illness.
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Trachtenberg FL, Gerstenberger E, Xu Y, Mednick L, Sobota A, Ware H, Thompson AA, Neufeld EJ, Yamashita R. Relationship among chelator adherence, change in chelators, and quality of life in thalassemia. Qual Life Res 2014; 23:2277-88. [PMID: 24682717 DOI: 10.1007/s11136-014-0671-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE Thalassemia, a chronic blood disease, necessitates life-long adherence to blood transfusions and chelation therapy to reduce iron overload. We examine stability of health-related quality of life (HRQOL) in thalassemia and adherence to chelation therapy over time, especially after changes in chelator choice. METHODS Thalassemia Longitudinal Cohort participants in the USA, UK, and Canada completed the SF-36v2 (ages 14+) and the PF-28 CHQ (parents of children <14 years). Chelation adherence was defined as self-reported percent of doses administered in the last 4 weeks. RESULTS Two hundred and fifty-eight adults/adolescents (mean 29.7 years) and 133 children (mean 8.5 years) completed a mean of 2.8-years follow-up. Children made few chelator changes, whereas a mean of 2.2 changes was observed among the 37% of adults/adolescents who made chelator changes, mainly due to patient preference or medical necessity. Physical HRQOL improved among those with lower iron burden (better health status) at baseline who made a single change in chelator, but declined among participants with multiple changes and/or high iron burden (worse health status). Mental health improved among participants with lower iron burden, but iron overload was negatively associated with social functioning. Adherence did not significantly change over follow-up except for an increase after a change from deferoxamine (DFO) infusion to oral deferasirox (p = 0.03). Predictors of lower adherence for adults/adolescents at follow-up included side effects, smoking, younger age, problems preparing DFO, increased number of days per week DFO prescribed, and lower physical quality of life . CONCLUSIONS Strategies to balance medical needs with family, work, and personal life may assist in adherence.
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Kostopoulou AG, Tsiapras DP, Chaidaroglou AS, De giannis DE, Farmakis D, Kremastinos DT. The pathophysiological relationship and clinical significance of left atrial function and left ventricular diastolic dysfunction in β-thalassemia major. Am J Hematol 2014; 89:13-8. [PMID: 24038100 DOI: 10.1002/ajh.23581] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 01/26/2023]
Abstract
Iron deposition in combination with inflammatory and immunogenetic factors is involved in the pathophysiology of cardiac dysfunction in β-thalassemia major. We investigated the mechanical and endocrine function of the left atrium and ventricle to identify early signs of dysfunction. We studied 90 patients (mean age: 29 ± 11 years) with β-thalassemia and normal left ventricular function and 90 age and sex-matched healthy controls. Patients and controls underwent a thorough cardiac echocardiographic study and measurements of the b-type (NT-proBNP) and atrial natriuretic peptides (proANP). Patients underwent 24-hr Holter recordings for arrhythmia monitoring. In the patient group, atria were affected early during the course of the disease, prior to diastolic and systolic left ventricular dysfunction. The E/E'ratio (E Doppler mitral fast inflow to the corresponding tissue Doppler E) continually increased with age (P < 0.05) and reached levels indicating left ventricular diastolic dysfunction (E/E' > 15) in the third decade whereas indexes of active and passive atrial function decreased gradually throughout life. In controls, the E/E' ratio continually increased with age but with later (fifth decade) appearance of diastolic dysfunction and a compensatory increase in atrial active function. Both natriuretic peptides were significantly increased in patients compared to controls (558 ± 141 and 2,580 ± 1,830 fmol/mL for NT-proBNP and proANP versus 332 ± 106 and 1,331 ± 1,134 fmol/mL, respectively). Atrial fibrillation was found in a subgroup of 23 (26%) patients, older in age with mild diastolic function and enlarged, depressed atria. In conclusion, atrial mechanical depression seems to be a very early sign of cardiac damage. It may become echocardiographically evident even before diastolic and systolic dysfunction and is associated to supraventricular arrhythmias.
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Affiliation(s)
| | - Dimitrios P. Tsiapras
- Laboratory of Molecular Immunology and Histocompatibility; Onassis Cardiac Surgery Center; Athens Greece
| | - Antigoni S. Chaidaroglou
- Laboratory of Molecular Immunology and Histocompatibility; Onassis Cardiac Surgery Center; Athens Greece
| | - Dimitrios E. De giannis
- Laboratory of Molecular Immunology and Histocompatibility; Onassis Cardiac Surgery Center; Athens Greece
| | - Dimitrios Farmakis
- First Department of Internal Medicine; University of Athens Medical School; Laiko Hospital Athens Greece
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Hatzipantelis ES, Karasmanis K, Perifanis V, Vlachaki E, Tziomalos K, Economou M. Combined chelation therapy with deferoxamine and deferiprone in β-thalassemia major: compliance and opinions of young thalassemic patients. Hemoglobin 2013; 38:111-4. [PMID: 24351163 DOI: 10.3109/03630269.2013.867407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Treatment of β-thalassemia major (β-TM) includes regular blood transfusions and iron chelation with subcutaneous injection of deferoxamine (DFO). During the last decade, a new chelation agent, deferiprone (L1), was introduced. The purpose of our study was to determine the level of awareness/education regarding chelation therapy, the degree of compliance to this therapy and their views of L1 in patients with β-TM. A relevant questionnaire was administered to 36 patients (12-26 years old) who were on combination chelation therapy with both DFO and L1. The majority of patients was well aware/educated about chelation therapy (76.6%), was compliant with this therapy (74.4%) and had a positive view towards oral chelation (86.0%). In conclusion, most patients with β-TM who were on combination chelation therapy with DFO and L1 were satisfied with this treatment and this results in high compliance rates.
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Affiliation(s)
- Emmanuel S Hatzipantelis
- Thalassaemia Unit, First Paediatric Department of Aristotle University, Hippokration General Hospital of Thessaloniki , Thessaloniki , Greece
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Abstract
At the center of iron and oxidant metabolism is the ferritin superfamily: protein cages with Fe(2+) ion channels and two catalytic Fe/O redox centers that initiate the formation of caged Fe2O3·H2O. Ferritin nanominerals, initiated within the protein cage, grow inside the cage cavity (5 or 8 nm in diameter). Ferritins contribute to normal iron flow, maintenance of iron concentrates for iron cofactor syntheses, sequestration of iron from invading pathogens, oxidant protection, oxidative stress recovery, and, in diseases where iron accumulates excessively, iron chelation strategies. In eukaryotic ferritins, biomineral order/crystallinity is influenced by nucleation channels between active sites and the mineral growth cavity. Animal ferritin cages contain, uniquely, mixtures of catalytically active (H) and inactive (L) polypeptide subunits with varied rates of Fe(2+)/O2 catalysis and mineral crystallinity. The relatively low mineral order in liver ferritin, for example, coincides with a high percentage of L subunits and, thus, a low percentage of catalytic sites and nucleation channels. Low mineral order facilitates rapid iron turnover and the physiological role of liver ferritin as a general iron source for other tissues. Here, current concepts of ferritin structure/function/genetic regulation are discussed and related to possible therapeutic targets such as mini-ferritin/Dps protein active sites (selective pathogen inhibition in infection), nanocage pores (iron chelation in therapeutic hypertransfusion), mRNA noncoding, IRE riboregulator (normalizing the ferritin iron content after therapeutic hypertransfusion), and protein nanovessels to deliver medicinal or sensor cargo.
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Affiliation(s)
- Elizabeth C Theil
- Children's Hospital Oakland Research Institute (CHORI) , 5700 Martin Luther King Jr. Way, Oakland, California 94609, United States , and Department of Molecular and Structural Biochemistry, North Carolina State University , Raleigh, North Carolina 2765-7622, United States
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42
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Ambati SR, Randolph RE, Mennitt K, Kleinert DA, Weinsaft JW, Giardina PJ. Longitudinal monitoring of cardiac siderosis using cardiovascular magnetic resonance T2* in patients with thalassemia major on various chelation regimens: a 6-year study. Am J Hematol 2013; 88:652-6. [PMID: 23640778 DOI: 10.1002/ajh.23469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 01/19/2023]
Abstract
Cardiovascular magnetic resonance (CMR) and hepatic magnetic resonance imaging (MRI) have become reliable noninvasive tools to monitor iron excess in thalassemia major (TM) patients. However, long-term studies are lacking. We reviewed CMR and hepatic MRI T2* imaging on 54 TM patients who had three or more annual measurements. They were managed on various chelation regimens. Patients were grouped according to their degree of cardiac siderosis: severe (T2*, <10 msec), mild to moderate (T2* = 10-20 msec), and no cardiac siderosis (T2*, >20 msec). We looked at the change in cardiac T2*, liver iron concentration (LIC) and left ventricular ejection fraction (LVEF) at years 3 and 5. In patients with severe cardiac siderosis, cardiac T2* (mean ± SD) improved from 6.9 ± 1.6 at baseline to 13.6 ± 10.0 by year 5, mean ΔT2* = 6.7 (P = 0.04). Change in cardiac T2* at year 3 was not significant in the severe group. Patients with mild to moderate cardiac siderosis had mean cardiac T2* of 14.6 ± 2.9 at baseline which improved to 26.3 ± 9.5 by year 3, mean ΔT2* = 1.7 (P = 0.01). At baseline, median LICs (mg/g dry weight) in patients with severe, mild-moderate, and no cardiac siderosis were 3.6, 2.8, and 3.3, whereas LVEFs (mean ± SD) (%) were 56.3 ± 10.1, 60 ± 5, and 66 ± 7.6, respectively. No significant correlation was noted between Δ cardiac T2* and Δ LIC, Δ cardiac T2*, and Δ LVEF at years 3 and 5. Throughout the observation period, patients with no cardiac siderosis maintained their cardiac T2* above 20 msec. The majority of patients with cardiac siderosis improve cardiac T2* over time with optimal chelation.
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Affiliation(s)
- Srikanth R. Ambati
- Department of Pediatrics; Memorial Sloan-Kettering Cancer Center; New York; New York
| | - Rachel E. Randolph
- Department of Pediatrics; Weill Cornell Medical College; New York; New York
| | - Kevin Mennitt
- Department of Radiology; Weill Cornell Medical College; New York; New York
| | | | - Jonathan W. Weinsaft
- Cardiac MR/CT Imaging Program; Division of Cardiology, Weill Cornell Medical College; New York; New York
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43
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Taher AT, Viprakasit V, Musallam KM, Cappellini MD. Treating iron overload in patients with non-transfusion-dependent thalassemia. Am J Hematol 2013; 88:409-15. [PMID: 23475638 PMCID: PMC3652024 DOI: 10.1002/ajh.23405] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/21/2013] [Accepted: 01/23/2013] [Indexed: 01/19/2023]
Abstract
Despite receiving no or only occasional blood transfusions, patients with non-transfusion-dependent thalassemia (NTDT) have increased intestinal iron absorption and can accumulate iron to levels comparable with transfusion-dependent patients. This iron accumulation occurs more slowly in NTDT patients compared to transfusion-dependent thalassemia patients, and complications do not arise until later in life. It remains crucial for these patients' health to monitor and appropriately treat their iron burden. Based on recent data, including a randomized clinical trial on iron chelation in NTDT, a simple iron chelation treatment algorithm is presented to assist physicians with monitoring iron burden and initiating chelation therapy in this group of patients. Am. J. Hematol. 88:409–415, 2013. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Ali T. Taher
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirut Lebanon
| | - Vip Viprakasit
- Department of Pediatrics and Siriraj‐Thalassemia CenterFaculty of MedicineSiriraj HospitalMahidol UniversityBangkok Thailand
| | - Khaled M. Musallam
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirut Lebanon
- Department of Medicine and Medical SpecialitiesUniversitá di MilanoCa' Granda Foundation IRCCSMilan Italy
| | - M. Domenica Cappellini
- Department of Medicine and Medical SpecialitiesUniversitá di MilanoCa' Granda Foundation IRCCSMilan Italy
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44
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Viprakasit V, Nuchprayoon I, Chuansumrit A, Torcharus K, Pongtanakul B, Laothamatas J, Srichairatanakool S, Pooliam J, Supajitkasem S, Suriyaphol P, Tanphaichitr VS, Tuchinda S. Deferiprone (GPO-L-ONE(®) ) monotherapy reduces iron overload in transfusion-dependent thalassemias: 1-year results from a multicenter prospective, single arm, open label, dose escalating phase III pediatric study (GPO-L-ONE; A001) from Thailand. Am J Hematol 2013; 88:251-60. [PMID: 23460233 DOI: 10.1002/ajh.23386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/19/2012] [Accepted: 12/24/2012] [Indexed: 01/19/2023]
Abstract
Accessibility to iron chelators including deferoxamine and deferasirox remains obscured in many developing countries. To provide an alternative, the government pharmaceutical organization of Thailand (GPO) manufactured deferiprone which has similar bioequivalent to the standard product. Seventy-three pediatric patients with severe β thalassemias, age range 3.2-19 years, were recruited to a 1-year multicenter prospective, single arm, open label, dose escalating Phase III study of deferiprone to determine its clinical efficacy and safety. Sixty-four patients (87.6%) completed the study with good compliance (>94%). Average deferiprone dose was 79.1±4.3 mg/kg/day. Overall, mean serum ferritin (SF) levels at 1 year were not significantly changed from baseline. However, 45% of patients (response group) had SF reduced >15% from baseline at 1 year with a median reduction of 1,065 ng ml(-1) . Baseline SF was the major factor that predicts clinical efficacy; patients with baseline SF>3,500 ng ml(-1) had the most significant fall of SF at 1 year. A subgroup analysis by MRI-T2* confirmed that the response group had higher baseline liver iron and deferiprone could significantly reduce liver iron overload and normalize levels of ALT at 1 year. Although, gastrointestinal irritation (20.5%) was the most common drug-related adverse events (AEs) followed by transaminitis (16.4%) and neutropenia (6.8%), all patients were well tolerated. There was no mortality and agranulocytosis found in this trial. Monotherapy of deferiprone with appropriate dose adjustment and monitoring for adverse events appeared to be an effective chelation therapy in some patients with good compliance and acceptable safety profiles.
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Affiliation(s)
- Vip Viprakasit
- Hematology/Oncology Division, Department of Pediatrics and Thalassemia Center; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Issarang Nuchprayoon
- Department of Pediatrics; King Chulalongkorn Memorial Hospital, Chulalongkorn University; Bangkok Thailand
| | - Ampaiwan Chuansumrit
- Department of Pediatrics; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Kitti Torcharus
- Department of Pediatrics; Phramongkutklao College of Medicine; Bangkok Thailand
| | - Bunchoo Pongtanakul
- Hematology/Oncology Division, Department of Pediatrics and Thalassemia Center; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Jiraporn Laothamatas
- Department of Radiology; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Somdet Srichairatanakool
- Department of Biochemistry; Faculty of Medicine; Chiang Mai University; Chiang Mai, Bangkok Thailand
| | - Julaporn Pooliam
- Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Siriwat Supajitkasem
- Bioinformatics and Data Management for Research Unit; Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Prapat Suriyaphol
- Bioinformatics and Data Management for Research Unit; Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Voravarn S. Tanphaichitr
- Hematology/Oncology Division, Department of Pediatrics and Thalassemia Center; Faculty of Medicine Siriraj Hospital, Mahidol University; Bangkok Thailand
- Thalassemia Foundation of Thailand (TFT); Bangkok Thailand
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Armstrong EP, Skrepnek GH, Sasane M, Snodgrass SM, Ballas SK. Long-term persistency and costs associated with the use of iron chelation therapies in the treatment of Sickle cell disease within Medicaid programs. J Med Econ 2013; 16:10-8. [PMID: 22947171 DOI: 10.3111/13696998.2012.723081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This retrospective study evaluated iron chelating therapy (ICT) discontinuation and costs in Sickle cell disease (SCD) Medicaid recipients using healthcare claims from 2006-2010. METHODS Patients with ≥1 SCD diagnosis claim, ≥2 claims for deferoxamine (DFO) or deferosirox (DFX), and continuous enrollment ≥6 months prior to and 18 months following ICT initiation were included. Outcomes included treatment discontinuation, persistence (i.e., refill gaps ≥6 weeks), and total healthcare costs. RESULTS The average age among 404 SCD patients meeting study inclusion criteria was 18.7 (±11.0) years, with 45.8% being males and 66.7% being Blacks. Switches or combinations from DFO at index occurred in 124 (74.7%) patients compared to 10 (4.2%) with DFX at index. The Cox regression model that assessed long-term medication persistence indicated a 1.30-times higher likelihood of treatment discontinuation with DFO compared to DFX (95% CI: 1.06-1.61). Some 19.7% of patient remained on DFX relative to 4.8% on DFO. Both inpatient and total costs were similar in DFX and DFO treatment groups. Following 1 year of treatment, 37.4% remained on DFX compared to 15.7% on DFO. Meaningful differences in treatment discontinuation between the two treatment groups did not occur until 220+ days during the study period. At 18-months, treatment discontinuation rates were high in both groups; 95% for DFO and 80% for DFX. CONCLUSION This study of SCD Medicaid patients found more therapeutic switches from DFO to DFX and a higher medication persistency rate with DFX than DFO. The conclusions are limited by the study's retrospective nature, which depends on multivariate statistics to account for patient heterogeneity and risk factors.
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46
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Trachtenberg FL, Mednick L, Kwiatkowski JL, Neufeld EJ, Haines D, Pakbaz Z, Thompson AA, Quinn CT, Grady R, Sobota A, Olivieri N, Horne R, Yamashita R. Beliefs about chelation among thalassemia patients. Health Qual Life Outcomes 2012; 10:148. [PMID: 23216870 PMCID: PMC3545841 DOI: 10.1186/1477-7525-10-148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/27/2012] [Indexed: 01/19/2023] Open
Abstract
Background Understanding patients’ views about medication is crucial to maximize adherence. Thalassemia is a congenital blood disorder requiring chronic blood transfusions and daily iron chelation therapy. Methods The Beliefs in Medicine Questionnaire (BMQ) was used to assess beliefs in chelation in thalassemia patients from North America and London in the Thalassemia Longitudinal Cohort (TLC) of the Thalassemia Clinical Research Network (TCRN). Chelation adherence was based on patient report of doses administered out of those prescribed in the last four weeks. Results Of 371 patients (ages 5-58y, mean 24y), 93% were transfused and 92% receiving chelation (26% deferoxamine (DFO; a slow subcutaneous infusion via portable pump), 63% oral, 11% combination). Patients expressed high “necessity” for transfusion (96%), DFO chelation (92%) and oral chelation (89%), with lower “concern” about treatment (48%, 39%, 19% respectively). Concern about oral chelation was significantly lower than that of DFO (p<0.001). Self-reported adherence to chelation was not associated with views about necessity or concerns, but negatively correlated with perceived sensitivity to DFO (Sensitive Soma scale; r=−0.23, p=0.01) and side effects of oral chelation (r=−0.14, p=0.04). High ferritin iron levels, potentially indicating lower adherence, were found in 41% of patients reporting low necessity of oral chelation compared to 24% reporting high necessity (p=0.048). Concerns about treatment were associated with lower quality of life and more symptoms of anxiety and depression. Conclusions Despite their requirement for multimodal therapy, thalassemia patients have positive views about medicine, more so than in other disease populations. Patients may benefit from education about the tolerability of chelation and strategies to effectively cope with side effects, both of which might be beneficial in lowering body iron burden. Clinicaltrials.gov identifier NCT00661804
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47
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Li C, Wu X, Feng X, He Y, Liu H, Pei F, Liao J, He L, Shi L, Li N, Liu Q, Liu S, Chen G, Su Q, Ren Y, Wang Y, Tan W. A novel conditioning regimen improves outcomes in β-thalassemia major patients using unrelated donor peripheral blood stem cell transplantation. Blood 2012; 120:3875-81. [DOI: 10.1182/blood-2012-03-417998] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
We used a novel NF-08-TM transplant protocol based on intravenous busulfan, cyclophosphamide, fludarabine, and thiotepa in 82 consecutive patients with β-thalassemia major (TM), including 52 with allogeneic peripheral blood stem cell transplantation (PBSCT) from unrelated donors (UDs) with well-matched human leukocyte antigens and 30 with hematopoietic stem cell transplantation (HSCT) from matched sibling donors (MSDs). The median age at transplantation was 6.0 years (range, 0.6-15.0 years), and the ratio of male-to-female patients was 56:26. The median follow-up time was 24 months (range, 12-39 months). The estimated 3-year overall survival and TM-free survival were 92.3% and 90.4% in the UD-PBSCT group and 90.0% and 83.3% in the MSD-HSCT group. The cumulative incidences of graft rejection and grades III-IV acute graft-versus-host disease were 1.9% and 9.6%, respectively, in the UD-PBSCT group and 6.9% and 3.6%, respectively, in the MSD-HSCT group. The cumulative incidence of transplant-related mortality was 7.7% in the UD-PBSCT group and 10.0% in the MSD-HSCT group. In conclusion, UD-PBSCTs using the well-tolerated NF-08-TM protocol show similar results to MSD-HSCTs and can be used to treat β-thalassemia patients in the absence of MSDs.
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Abstract
In this report, we review the recent advances in evaluation and treatment of transfusional iron overload (IO). Results of the French thalassaemia registry are described. According to the disease, thalassaemia major or sickle cell anaemia, mechanisms and toxicity of iron overload, knowledge about IO long-term outcome and chelation treatment results, respective value of IO markers, differ. The recent tools evaluating organ specific IO and the diversification of iron chelator agents make possible to individualize chelation therapy in clinical practice. The severity of IO and the level of transfusional iron intake, the preferential localization of IO (heart/liver) as well as the tolerance and adherence profiles of the patient can now be taken into account. Introduction of cardiac magnetic resonance imaging for the quantification of myocardial iron and use of oral chelators have already been reported as decreasing the cardiac mortality rate related to IO in thalassaemia major patients. Long-term observation of patients under oral chelators will show if morbidity is also improving via a more continuous control of toxic iron and/or a better accessibility to cellular iron pools.
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Affiliation(s)
- Isabelle Thuret
- Service d'hématologie pédiatrique, centre de référence des Thalassémies, hôpital d'Enfants de la Timone, AP-HM, 13385 Marseille cedex 5, France.
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49
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Porter J, Bowden DK, Economou M, Troncy J, Ganser A, Habr D, Martin N, Gater A, Rofail D, Abetz-Webb L, Lau H, Cappellini MD. Health-Related Quality of Life, Treatment Satisfaction, Adherence and Persistence in β-Thalassemia and Myelodysplastic Syndrome Patients with Iron Overload Receiving Deferasirox: Results from the EPIC Clinical Trial. Anemia 2012; 2012:297641. [PMID: 22924125 DOI: 10.1155/2012/297641] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 05/01/2012] [Accepted: 05/19/2012] [Indexed: 01/19/2023] Open
Abstract
Treatment of iron overload using deferoxamine (DFO) is associated with significant deficits in patients' health-related quality of life (HRQOL) and low treatment satisfaction. The current article presents patient-reported HRQOL, satisfaction, adherence, and persistence data from β-thalassemia (n = 274) and myelodysplastic syndrome (MDS) patients (n = 168) patients participating in the Evaluation of Patients' Iron Chelation with Exjade (EPIC) study (NCT00171821); a large-scale 1-year, phase IIIb study investigating the efficacy and safety of the once-daily oral iron chelator, deferasirox. HRQOL and satisfaction, adherence, and persistence to iron chelation therapy (ICT) data were collected at baseline and end of study using the Medical Outcomes Short-Form 36-item Health Survey (SF-36v2) and the Satisfaction with ICT Questionnaire (SICT). Compared to age-matched norms, β-thalassemia and MDS patients reported lower SF-36 domain scores at baseline. Low levels of treatment satisfaction, adherence, and persistence were also observed. HRQOL improved following treatment with deferasirox, particularly among β-thalassemia patients. Furthermore, patients reported high levels of satisfaction with deferasirox at end of study and greater ICT adherence, and persistence. Findings suggest deferasirox improves HRQOL, treatment satisfaction, adherence, and persistence with ICT in β-thalassemia and MDS patients. Improving such outcomes is an important long-term goal for patients with iron overload.
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50
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Grady RW, Galanello R, Randolph RE, Kleinert DA, Dessi C, Giardina PJ. Toward optimizing the use of deferasirox: potential benefits of combined use with deferoxamine. Haematologica 2012; 98:129-35. [PMID: 22875626 DOI: 10.3324/haematol.2012.070607] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Patients with β-thalassemia require iron chelation therapy to protect against progressive iron overload and non-transferrin-bound iron. Some patients fail to respond adequately to deferoxamine and deferasirox monotherapy while others have side effects which limit their use of these drugs. Since combining deferiprone and deferoxamine has an additive effect, placing all patients into net negative iron balance, we investigated the possibility that combining deferasirox and deferoxamine would lead to similar results. We conducted 34-day metabolic iron balance studies in six patients in whom the relative effectiveness of deferasirox (30 mg/kg/day) and deferoxamine (40 mg/kg/day) was compared, alone and in combination. Patients consumed fixed low-iron diets; daily urinary and stool iron excretion were determined by atomic absorption. Red blood cell transfusions were given prior to each drug treatment to minimize the effects of ineffective erythropoiesis. Serial safety measures, hematologic parameters, serum chemistries, ferritin levels and urinalyses were determined. All patients were in negative iron balance when treated with deferoxamine alone while four of six patients remained in positive balance when deferasirox monotherapy was evaluated. Daily use of both drugs had a synergistic effect in two patients and an additive effect in three others. Five of six patients would be in negative iron balance if they used the combination of drugs just 3 days a week. No significant or drug-related changes were observed in the blood work-ups or urinalyses performed. We conclude that supplementing the daily use of deferasirox with 2 - 3 days of deferoxamine therapy would place all patients into net negative iron balance thereby providing a convenient way to tailor chelation therapy to the individual needs of each patient.
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Affiliation(s)
- Robert W Grady
- Division of Pediatric Hematology/Oncology, New York Presbyterian Hospital, New York, NY, USA.
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