Combined and alternative iron chelator drugs in treatment of thalassemia major

Objective: To assess the efficacy and safety of the sequential deferoxamine (DFO) and deferasirox/Osveral (OSV) [(Seq OSV/DFO)] protocol and combinations of Deferroxamine/ Deferiprone (Com DFO/DEF) in thalassemia major (TM) patients. Methodology: A total of 148 male and 142 female patients of thalassemia major (TM) were enrolled in these studies. Out of 290 patients sixty two (31 male, 31 female) aged 6 to 30 years (mean: 18.5) entered into Seq OSV/DFO study and 228 TM (117 male, 111 female) aging 2 through 36 years (mean: 17) were eligible for Com DFO/DEF trial. Seq OSV/DFO was a regimen consisted of four days Osveral followed by three days deferoxamine and Com DFO/DEF was a protocol of DEF seven days a week, along with DFO of a minimum of two to four nights per week The duration of trial was six months. The efficacy was determined by comparison of pre and post treatment ferritin and safety was assessed by frequency of adverse drugs reaction (ADR). Results: For both regimens serum ferritin declined significantly and compliance response was excellent. During trials 33.8% and 21% of patients experienced at least one ADR for combination and sequential respectively. Conclusion: Deferoxamine (DFO) /deferasirox (OSV) and Deferroxamine/Deferiprone(DEF) are acceptable regimens with high efficacy, low toxicity and excellent compliances.