title: Role of vitamin C as an adjuvant therapy to different iron chelators in young β-thalassemia major patients: efficacy and safety in relation to tissue iron overload.
abstract: BACKGROUND
  Vitamin C, as antioxidant, increases the efficacy of deferoxamine (DFO).
  
  
  OBJECTIVE
  To investigate the effects of vitamin C as an adjuvant therapy to the three used iron chelators in moderately iron-overloaded young vitamin C-deficient patients with β-thalassemia major (β-TM) in relation to tissue iron overload.
  
  
  METHODS
  This randomized prospective trial that included 180 β-TM vitamin C-deficient patients were equally divided into three groups (n = 60) and received DFO, deferiprone (DFP), and deferasirox (DFX). Patients in each group were further randomized either to receive vitamin C supplementation (100 mg daily) or not (n = 30). All patients received vitamin C (group A) or no vitamin C (group B) were followed up for 1 yr with assessment of transfusion index, hemoglobin, iron profile, liver iron concentration (LIC) and cardiac magnetic resonance imaging (MRI) T2*.
  
  
  RESULTS
  Baseline vitamin C was negatively correlated with transfusion index, serum ferritin (SF), and LIC. After vitamin C therapy, transfusion index, serum iron, SF, transferrin saturation (Tsat), and LIC were significantly decreased in group A patients, while hemoglobin and cardiac MRI T2* were elevated compared with baseline levels or those in group B without vitamin C. The same improvement was found among DFO-treated patients post-vitamin C compared with baseline data. DFO-treated patients had the highest hemoglobin with the lowest iron, SF, and Tsat compared with DFP or DFX subgroups.
  
  
  CONCLUSIONS
  Vitamin C as an adjuvant therapy possibly potentiates the efficacy of DFO more than DFP and DFX in reducing iron burden in the moderately iron-overloaded vitamin C-deficient patients with β-TM, with no adverse events.
authors.affiliation: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohsen S
authors.initials: MS
authors.lastname: Elalfy
authors.affiliation: Child Health in Complementary Medicine, National Research Center, Cairo, Egypt.
authors.forename: Maha M
authors.initials: MM
authors.lastname: Saber
authors.affiliation: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Amira Abdel Moneam
authors.initials: AA
authors.lastname: Adly
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Eman A
authors.initials: EA
authors.lastname: Ismail
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tarif
authors.affiliation: Child Health in Complementary Medicine, National Research Center, Cairo, Egypt.
authors.forename: Fatma
authors.initials: F
authors.lastname: Ibrahim
authors.affiliation: Child Health in Complementary Medicine, National Research Center, Cairo, Egypt.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Elalfy
mesh_terms: D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D001206:Ascorbic Acid Deficiency / Q000188:drug therapy / Q000209:etiology; D015415:Biomarkers; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007501:Iron / Q000378:metabolism; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019190:Iron Overload / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016896:Treatment Outcome; D017086:beta-Thalassemia / Q000150:complications* / Q000628:therapy
chemical_list: D015415:Biomarkers; D007502:Iron Chelating Agents; D007501:Iron; D001205:Ascorbic Acid
keywords: cardiac MRI T2*; iron chelators; thalassemia major; tissue iron overload; vitamin C