title: Safety profiles of iron chelators in young patients with haemoglobinopathies.
abstract: BACKGROUND
  This review describes the safety of deferoxamine (DFO), deferiprone (DFP), deferasirox (DFX) and combined therapy in young patients less than 25 yr of age with haemoglobinopathies.
  
  
  METHODS
  Searches in electronic literature databases were performed. Studies reporting adverse events associated with iron chelation therapy were included. Study and reporting quality was assessed using AHRQ Risk of Bias Assessment Tool and McMaster Quality Assessment Scale of Harms. Prospective clinical studies were pooled in a random-effects meta-analysis of proportions.
  
  
  RESULTS
  Safety data of 2040 patients from 34 studies were included. Ninety-two case reports of 246 patients were identified. DFX (937 patients) and DFP (667 patients) possess the largest published safety evidence. Fewer studies on combination regimens are available. Increased transaminases were seen in all regimens (3.9-31.3%) and gastrointestinal disorders with DFP and DFX (3.7-18.4% and 5.8-18.8%, respectively). Therapy discontinuations due to adverse events were low (0-4.1%). Reporting quality was selective and poor in most of the studies.
  
  
  CONCLUSIONS
  Iron chelation therapy is generally safe in young patients, and published data correspond to summary of product characteristics. Each iron chelation regimen has its specific safety risks. DFO seems not to be associated with serious adverse effects in recommended doses. In DFP and DFX, rare, but serious, adverse reactions can occur. Data on combined therapy are scarce, but it seems equally safe compared to monotherapy.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Botzenhardt
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, University of Hong Kong, Hong Kong, China.|Clinical Trials Center, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
authors.forename: Niya
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, University of Hong Kong, Hong Kong, China.
authors.forename: Esther W
authors.initials: EW
authors.lastname: Chan
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, University of Hong Kong, Hong Kong, China.
authors.forename: Chor Wing
authors.initials: CW
authors.lastname: Sing
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, University of Hong Kong, Hong Kong, China.|Research Department of Practice & Policy, University College London School of Pharmacy, London, UK.
authors.forename: Ian C K
authors.initials: IC
authors.lastname: Wong
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Neubert
mesh_terms: D015913:Chelation Therapy; D004359:Drug Therapy, Combination; D006453:Hemoglobinopathies / Q000150:complications* / Q000628:therapy; D006801:Humans; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019190:Iron Overload / Q000188:drug therapy* / Q000209:etiology*; D065227:Transfusion Reaction
chemical_list: D007502:Iron Chelating Agents
keywords: adverse drug reactions; children; deferasirox; deferiprone; deferoxamine; haemoglobinopathies