TY - JOUR
TI - Iron chelation therapy in thalassemia major: A systematic review with
meta-analyses of 1520 patients included on randomized clinical trials
AU - Maggio, Aurelio
AU - Filosa, Aldo
AU - Vitrano, Angela
AU - Aloj,
AU - Giuseppina
AU - Kattamis, Antonis
AU - Ceci, Adriana
AU - Fucharoen, Suthat
AU - and Cianciulli, Paolo
AU - Grady, Robert W.
AU - Prossomariti, Luciano and
AU - Porter, John B.
AU - Iacono, Angela
AU - Cappellini, Maria Domenica and
AU - Bonifazi, Fedele
AU - Cassara, Filippo
AU - Harmatz, Paul
AU - Wood, John
AU - and Gluud, Christian
JO - BLOOD CELLS MOLECULES AND DISEASES
PY - 2011
VL - 47
TODO - 3
SP - 166-175
PB - ACADEMIC PRESS INC ELSEVIER SCIENCE
SN - 1079-9796
TODO - 10.1016/j.bcmd.2011.07.002
TODO - null
TODO - The effectiveness of deferoxamine (DFO), deferiprone (DFP), or
deferasirox (DFX) in thalassemia major was assessed. Outcomes were
reported as means +/- SD, mean differences with 95% CI, or standardized
mean differences. Statistical heterogeneity was tested using chi(2) (Q)
and I-2. Sources of bias and Grading of Recommendations Assessment,
Development and Evaluation system (GRADE) were considered. Overall, 1520
patients were included. Only 7.4% of trials were free of bias. Overall
measurements suggest low trial quality (GRADE). The meta-analysis
suggests lower final liver iron concentrations during associated versus
monotherapy treatment (p<0.0001), increases in serum ferritin levels
during DFX 5, 10, and 20 mg/kg versus DFO-treated groups (p<0.00001,
p<0.00001, and p = 0.002, respectively), but no statistically
significant difference during DFX 30 mg/kg versus DFO (p = 0.70), no
statistically significant variations in heart T2* signal during
associated or sequential versus mono-therapy treatment (p = 0.46 and p =
0.14, respectively), increases in urinary iron excretion during
associated or sequential versus monotherapy treatment (p = 0.008 and p =
0.02, respectively), and improved ejection fraction during associated or
sequential versus monotherapy treatment (p = 0.01 and p<0.00001,
respectively). These findings do not support any specific chelation
treatment. The literature shows risks of bias, and additional larger and
longer trials are needed. (C) 2011 Elsevier Inc. All rights reserved.
ER -