Subcutaneous bolus injection of deferoxamine is an alternative method to subcutaneous continuous infusion.
The objective of this study was to compare the short- and long-term efficacy of deferoxamine (DFO) given by subcutaneous (SC) continuous infusion over 10 hours via a pump (n = 10) versus a twice-daily subcutaneous bolus injection of the same overall dose (n = 10) in 20 thalassemic children. Urinary iron excretion was measured in 24-hour urine samples after DFO treatment in the 20 patients. The patients were randomized to two groups: 10 patients continued SC continuous infusion with a pump and the remaining 10 received the same overall dose of DFO by twice-daily SC bolus injection for a year. Serum ferritin levels and T1-weighted spin-echo and T2-weighted fast spin-echo signal intensities of liver and paraspinal muscle were determined at initiation and 1 year after initiation of the therapy. In 12 patients, six from each group, liver biopsies were performed and hepatic iron concentration was determined at initiation of therapy and 1 year after treatment. A similar and significant decrease in ferritin levels and improvement in signal intensities of the liver were observed in response to chelation therapy with DFO in both groups (P < 0.01, within each group). Hepatic iron concentration decreased in all patients in the SC bolus injection group (P < 0.05) and in four patients in the SC continuous infusion group (P > 0.05). Hepatic iron concentration was noted to be slightly increased in two patients in the SC continuous infusion group, which may be due to poor compliance. Based on these results, twice-daily SC bolus injection of DFO is as effective as administration via SC continuous infusion using a pump. Subcutaneous bolus injection, being more convenient for the patient, may be a more preferable method of DFO administration.
Yarali
Neşe
N
Dr. Sami Ulus Children's Hospital, Department of Hematology, Ankara, Turkey. yarali@ada.net.tr
Fişgin
Tunç
T
Duru
Feride
F
Kara
Abdurrahman
A
Ecin
Nurhayat
N
Fitoz
Suat
S
Erden
Ilhan
I
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003676:Deferoxamine / Q000008:administration & dosage*; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007260:Infusion Pumps; D007279:Injections, Subcutaneous; D008099:Liver / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D017262:Siderophores / Q000008:administration & dosage*; D017086:beta-Thalassemia / Q000188:drug therapy*
D017262:Siderophores; D005293:Ferritins; D003676:Deferoxamine