title: Comparative efficacy and safety of deferoxamine, deferiprone and deferasirox on severe thalassemia: a meta-analysis of 16 randomized controlled trials.
abstract: OBJECTIVE
  A meta-analysis was conducted to investigate the efficacy and safety of three main iron chelators, namely, deferoxamine (DFO), deferiprone (DFP) and deferasirox (DFX) for thalassemia major (TM) patients.
  
  
  METHODS
  Randomized controlled trials comparing mono-therapy DFO, DFP, DFX and combined DFP with DFO therapy in TM patients from January 1990 to December 2012 were searched and selected. Two independent authors assessed data from extracted randomized trials for efficacy and safety in the measurements of serum ferritin (SF), live iron concentration (LIC), myocardial iron content (MIC), left ventricular ejection fraction (LVEF) and adverse events (AEs).
  
  
  RESULTS
  Sixteen studies were selected. In the comparison of DFP versus DFO treatment groups, a significant difference was revealed on MIC and LVEF (P=0.01 and P=0.007, respectively) but not on SF or LIC level (P=0.65 and P=0.37, respectively). In comparing combined therapy (DFP plus DFO) versus DFO, a significant difference was shown on MIC and LVEF measurements (P<0.00001 and P=0.003, respectively), but not on SF or LIC levels (P=0.93 and P=0.62, respectively). Moreover, the combined DFP with DFO treatment had significantly higher risk than DFO treatment (RR 1.46 with 95%CI 1.04 to 2.04). When comparing DFX with DFO, a significant difference was shown on the SF level (P=0.003), and there was no difference between DFX and DFO in safety evaluation (RR 1.53 with 95%CI 0.31 to 7.49).
  
  
  CONCLUSIONS
  Findings indicated that the most effective and safe iron chelators remains to be proven, and further large-scale, long-term studies are needed.
authors.affiliation: Division of Medical Statistics, School of Medicine, University of Jinan, Guangzhou City, Guangdong, China.
authors.forename: Sujian
authors.initials: S
authors.lastname: Xia
authors.affiliation: Novartis Pharmaceuticals Oncology, Beijing, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Zhuhai People's Hospital, Zhuhai City, Guangdong, China.
authors.forename: Liting
authors.initials: L
authors.lastname: Huang
authors.affiliation: Division of Medical Statistics, School of Medicine, University of Jinan, Guangzhou City, Guangdong, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
mesh_terms: D001565:Benzoates / Q000009:adverse effects* / Q000627:therapeutic use*; D000077588:Deferasirox; D000077543:Deferiprone; D003676:Deferoxamine / Q000009:adverse effects* / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000378:metabolism; D007502:Iron Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use; D008099:Liver / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000378:metabolism; D011728:Pyridones / Q000009:adverse effects* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D013789:Thalassemia / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D001565:Benzoates; D007502:Iron Chelating Agents; D011728:Pyridones; D014230:Triazoles; D000077543:Deferiprone; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine; D000077588:Deferasirox