Comparative effects of iron chelators on the transfusion-dependent Beta-Thalassemia Patients

Abstract

Background: Treatment of patients with thalassemia major consists of regular blood transfusions and iron chelation therapy, which is vital to prevent excess iron buildup in the body. In Bangladesh there are three iron chelating agents available: deferoxamine (DFO, Desferal), an iron chelator given by infusion, and two oral chelators deferiprone (DFP, Ferriprox) and deferasirox (DFX, Exjade). Objective: To compare the disease characteristics, comorbidities and quality of life of the patients with transfusion-dependent beta-thalassemia receiving three different chelation treatments. Methods: This was a cross-sectional descriptive type of study conducted at the Bangladesh Thalassemia Centre and Haematology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 175 attending transfusion-dependent beta-thalassemia patients between February 2012 and February 2013 were enrolled in this study, among them 135 (77.1%) patients were responded. Data were collected by self-administered questionnaires: SF-36 questionnaire and a personal questionnaire. Statistical analyses were performed with SPSS version 18.0 for Windows 7. Chi square test and univariate regression analysis were performed. Results: A total of 135 patients, 75(55.6%) patients were receiving DFX, 39(28.9%) were receiving combination therapy of DFO + DFP and the rest 21(15.5%) patients were receiving DFO alone. Mean hemoglobin level prior to transfusion (gm/dl) in DFX therapy recipients was significantly higher than the other two groups (p=0.0208). Highest percentage (92.3%) of the patients in DFO+DFP therapy garoup were moderately or highly physically active than the patients in DFO and DFX therapy groups. The patients receiving DFO had significantly higher percentages of myocardial dysfunction (33.3%), hepatic dysfunction (38.1%), splenectomy (71.4%) and allergies (14.3%) than the other two groups. A higher percentage of patients receiving DFO felt that their treatment negatively influenced their body and skin appearance and limited their ability to work, attend school, and perform daily tasks (P=0.0066). Conclusion: DFX or DFO+DFP therapy is more suitable choice for iron chelation treatment in transfusion-dependent beta-thalassemia patients than DFO therapy in term of comorbidities and quality of life in Bangladesh.