Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes.
OBJECTIVE
Iron overload adversely affects patients with myelodysplastic syndromes (MDS), but benefits of iron chelation therapy have not been clearly demonstrated. We examined the association between deferasirox (DFX) therapy and mortality in transfusion-receiving Medicare patients.


METHODS
MDS patients from 2005 to 2008 were identified using ICD-9 codes from 100% Medicare claims. Patients receiving ≥20 blood units were observed until death or end of study. Marginal structural models were used for estimation.


RESULTS
3926 patients (10.1% used DFX) were observed for a mean of 48.8 weeks. Each incremental week of DFX was associated with a significant reduction in mortality risk (hazard ratio [HR]: 0.989; 95% CI: 0.983-0.996; p = 0.001).


CONCLUSIONS
DFX therapy is associated with a reduced mortality risk among older MDS patients who received a minimum transfusion threshold.
Department of Internal Medicine, Section of Hematology, Yale University, New Haven, CT 06520, USA.
Amer M
AM
Zeidan
Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
Franklin
F
Hendrick
Department of Organizational Systems & Adult Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA.
Erika
E
Friedmann
Marlene & Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD 21201, USA.
Maria R
MR
Baer
Department of Internal Medicine, Section of Hematology, Yale University, New Haven, CT 06520, USA.
Steven D
SD
Gore
Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA.
Medha
M
Sasane
Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA.
Carole
C
Paley
Department of Health Policy & Management, Yale School of Public Health, Yale University, New Haven, CT 06520, USA.
Amy J
AJ
Davidoff
D000368:Aged; D001565:Benzoates / Q000627:therapeutic use*; D001803:Blood Transfusion; D000077588:Deferasirox; D005260:Female; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000188:drug therapy* / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy*; D040242:Risk Reduction Behavior; D014230:Triazoles / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D000077588:Deferasirox
deferasirox; iron chelation therapy; iron overload; mortality; myelodysplastic syndromes