Effectiveness and safety of ICL670 in iron-loaded patients with thalassaemia: a randomised, double-blind, placebo-controlled, dose-escalation trial.
BACKGROUND
Transfusional iron overload is a potentially fatal complication of the treatment of thalassaemia. We aimed to investigate short-term efficacy, pharmacokinetic/pharma- codynamic (PK/PD) relations, and safety of ICL670, a novel, tridentate, orally active iron chelator.


METHODS
We enrolled 24 patients and divided them into three cohorts consisting of a minimum of seven individuals. Patients were admitted to a metabolic unit and consumed a diet with a defined content of iron. Two patients in each cohort were randomly allocated placebo. Five or more patients received one daily dose of ICL670 at 10, 20, or 40 mg x kg(-1) x day(-1), from day 1 to 12. Net iron excretion (NIE) was measured between days 1 and 12. Primary objectives included assessment of safety and tolerability (measured by adverse events and clinical laboratory monitoring), pharmacokinetics (measured as drug and drug-iron complex), and cumulative net iron excretion (measured by faecal and urine output minus food input). Analysis was for efficacy.


RESULTS
ICL670 was absorbed promptly and was detectable in the blood for 24 h. Exposure (area under the curve of plasma concentration) to ICL670 at pharmacokinetic steady state was proportional to dose. All three doses resulted in positive NIE. The NIE achieved at 20mg x kg(-1) day(-1) would prevent net iron accumulation in most patients transfused with 12-15 mL packed red-blood-cells kg(-1) month(-1), equivalent to 0.3-0.5 mg iron kg(-1) x day(-1). A linear relation (PK/PD) was recorded between exposure to ICL670 and total iron excretion, by contrast with placebo (r2=0.54, p<0.0001). Skin rashes were noted in four patients treated at 20 and 40 mg x kg(-1) x day(-1), and one patient also developed grade 2 transaminitis.


CONCLUSIONS
ICL670 given once daily at 20 mg/kg seems to be an effective orally active iron chelator and is reasonably well tolerated. Long-term studies are now necessary to establish the practical contribution of this drug.
Department of Paediatrics, Harvard Medical School, Boston, MA, USA.
Eric
E
Nisbet-Brown
Nancy F
NF
Olivieri
Patricia J
PJ
Giardina
Robert W
RW
Grady
Ellis J
EJ
Neufeld
Romain
R
Séchaud
Axel J
AJ
Krebs-Brown
Judith R
JR
Anderson
Daniele
D
Alberti
Kurt C
KC
Sizer
David G
DG
Nathan
D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001565:Benzoates / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077588:Deferasirox; D003676:Deferoxamine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007408:Intestinal Absorption; D007501:Iron / Q000652:urine; D019190:Iron Overload / Q000150:complications / Q000188:drug therapy*; D008297:Male; D014230:Triazoles / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017086:beta-Thalassemia / Q000150:complications / Q000188:drug therapy*
D001565:Benzoates; D014230:Triazoles; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine; D000077588:Deferasirox