Comparative Efficacy of Deferiprone, Deferoxamine and Combination of Deferiprone and Deferoxamine on Serum Ferritin Value in Beta-Thalassemia Patients

Background: Iron overload is a predictable and life-threatening complication in patients with thalassemia. Effective and convenient iron chelation remains one of the main targets of clinical management of thalassemia major. The development of a safe and effective chelator has been the goal for many years. Aims and Objective: It was aimed to compare the effect of deferiprone, deferoxamine and combination of deferiprone and deferoxamine on serum ferritin value in beta-thalassemia patients. Material and Methods: This controlled clinical trial was conducted on 46 major beta-thalassemic patients. Fifteen patients in deferiprone group received deferiprone 75 mg/kg/day three times a day orally. Nineteen patients in deferoxamine group received deferoxamine 30-50 mg/kg/day subcutaneously for 8-12 hours/day and 5 days per week. Twelve patients in combined therapy group received deferiprone 75 mg/kg/day three times a day orally with deferoxamine 30-50 mg/kg subcutaneously every other day. Serum ferritin value was measured at the beginning and at the end of 6th and 12th months of study. Results: The mean of serum ferritin value in deferiprone group insignificantly increased from 2731 +/- 1398.5 mu g/L at the beginning to 2788.5 +/- 978.6 mu g/L and to 3331.8 +/- 1833.9 mu g/L at the end of 6th and 12th months of study, respectively. The mean of serum ferritin value in deferoxamine group insignificantly increased from 2883.5 +/- 1598.1 mu g/L at the beginning to 2935.3 +/- 1258.2 mu g/L at the end of 6th month of study and decreased to 2773.8 +/- 1216.1 mu g/L and 12th month of study. The mean of serum ferritin level in combined therapy group significantly decreased from 7498.7 +/- 3512.9 mu g/L at the beginning to 4839.9 +/- 2698.2 mu g/L (P < 0.001) and to 4298.2 +/- 2288.7 mu g/L (P < 0.001) at the end of 6th and 12th months of study, respectively. Conclusion: Combined therapy significantly decreases serum ferritin level. Study suggests deferiprone as a significant addition to support therapy in patients with betathalassemia major on regular transfusion regimens.