title: Deferiprone versus deferoxamine in patients with thalassemia major: a randomized clinical trial.
abstract: Deferiprone has been suggested as an effective oral chelation therapy for thalassemia major. To assess its clinical efficacy, we compared deferiprone with deferoxamine in a large multicenter randomized clinical trial. One-hundred forty-four consecutive patients with thalassemia major and serum ferritin between 1500 and 3000 ng/ml were randomly assigned to deferiprone (75 mg/kg/day) (n = 71) or deferoxamine (50 mg/kg/day) (n = 73) for 1 year. The main measure of efficacy was the reduction of serum ferritin. Liver and heart iron contents were assessed by magnetic resonance. Liver iron content and fibrosis stage variations were assessed on liver biopsy by the Ishak score in all patients willing to undergo liver biopsy before and after treatment. The mean serum ferritin reduction was 222 +/- 783 ng/ml in the deferiprone and 232 +/- 619 ng/ml in the deferoxamine group (P = 0.81). No difference in the reduction of liver and heart iron content was found by magnetic resonance between the two groups. Thirty-six patients accepted to undergo repeat liver biopsy: 21 in the deferiprone and 15 in the deferoxamine group. Their mean reduction of liver iron content was 1022 +/- 3511 microg/g of dry liver and 350 +/- 524, respectively (P = 0.4). No difference in variation of the Ishak fibrosis stage was observed between the two groups. Treatment was discontinued because of reversible side effects in 5 patients in the deferiprone group (3 hypertransamin/asemia and 2 leukocytopenia) and in none in the deferoxamine group. These findings suggest that deferiprone may be as effective as deferoxamine in the treatment of thalassemia major with few mild and reversible side effects.
authors.affiliation: Divisione di Ematologia II e Unità di Ricerca Piera Cutino, Azienda Ospedaliera V. Cervello, Palermo, Italy. aureliomaggio@virgilio.it
authors.forename: Aurelio
authors.initials: A
authors.lastname: Maggio
authors.forename: Gennaro
authors.initials: G
authors.lastname: D'Amico
authors.forename: Alberto
authors.initials: A
authors.lastname: Morabito
authors.forename: Marcello
authors.initials: M
authors.lastname: Capra
authors.forename: Calogero
authors.initials: C
authors.lastname: Ciaccio
authors.forename: Paolo
authors.initials: P
authors.lastname: Cianciulli
authors.forename: Felicia
authors.initials: F
authors.lastname: Di Gregorio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Garozzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Malizia
authors.forename: Carmelo
authors.initials: C
authors.lastname: Magnano
authors.forename: Antonino
authors.initials: A
authors.lastname: Mangiagli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Quarta
authors.forename: Michele
authors.initials: M
authors.lastname: Rizzo
authors.forename: Domenico Giuseppe
authors.initials: DG
authors.lastname: D'Ascola
authors.forename: Aroldo
authors.initials: A
authors.lastname: Rizzo
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000077543:Deferiprone; D003676:Deferoxamine / Q000008:administration & dosage* / Q000633:toxicity; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007502:Iron Chelating Agents / Q000008:administration & dosage* / Q000633:toxicity; D019190:Iron Overload / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D011728:Pyridones / Q000008:administration & dosage* / Q000633:toxicity; D013810:Therapeutic Equivalency; D016896:Treatment Outcome; D017086:beta-Thalassemia / Q000150:complications / Q000188:drug therapy*
chemical_list: D007502:Iron Chelating Agents; D011728:Pyridones; D000077543:Deferiprone; D005293:Ferritins; D003676:Deferoxamine