Effectiveness and safety of combined iron-chelation therapy with deferoxamine and deferiprone

Introduction: The purpose of our study was to evaluate the effectiveness and safety of combined therapy with deferoxamine (DFO) and deferiprone (DFP) in patients with beta-thalassemia major and increased serum ferritin. Patients and methods: Our study was performed in 36 patients with beta-thalassemia major. DFP was administered orally in a total daily dose of 60 mg/kg for 6 days per week and DFO was administered subcutaneously in a total daily dose of 40-50 mg/kg for 4-6 days per week. The efficacy of combined treatment was assessed by measurements of serum ferritin and 24-h urine iron excretion levels. Results: Out of the 36 patients, 11 discontinued DFO after a mean of 4 months; however, 25 patients, who continued to receive the combined therapy showed a very satisfactory compliance. After a mean of 13.5 months, their mean serum ferritin levels reduced from 2637 +/- 1292 to 1580 +/- 1024 ng/ml (P = 0.002) and their mean urinary iron excretion elevated from 0.41 +/- 0.27 to 0.76+/-0.49mg/24h (P=0.003). The observed side effects were gastrointestinal disorders, elevations in liver enzymes, mild neutropenia, joint symptoms, taste disorders, dizziness and fatigue. Conclusions: The results of this study show that combined iron-chelation therapy with DFO and DFP results in satisfactory reduction of serum ferritin with no significant toxicity.