Deferasirox and deferoxamine Used in refractory iron overloa
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Iron overload is a major complication of transfusion-dependent thalassemia (TDT) and requires iron chelation (IC) therapy. However, a combination therapy may be required for patients responding poorly to monotherapy.

9 TDT patients previously treated with IC were enrolled; 5 patients were previously treated with deferasirox (DFX) twice daily. The dose of DFX was 20–40 mg/kg/day, while the dose of deferoxamine (DFO) was 18–40 mg/kg/day for 3–6 days/week.

Results:
--At the 6 and 12-month time points, 6 and 8 patients demonstrated decreased serum ferritin levels, with median reductions of 707 ng/mL (range, 1,653–5,444 ng/mL) and 1,129 ng/mL (range, 1,781–7,725 ng/mL) compared to the baseline, respectively.

--8 patients also had a reduced liver iron concentration (LIC), with a median reduction of 3.9 mg/g dry wt (range, 8.3–11.1 mg/g dry wt).

--Of the 5 patients treated with DFX twice daily, 4 responded to combination therapy.

--All responsive patients could finally stop DFO after the decline in LIC. Moreover, there were no treatment-related complications.

Finally, the combination of DFX and DFO proved to be successful and safe for TDT patients who had previously failed to respond to standard IC therapy.

Source: https://onlinelibrary.wiley.com/doi/10.1111/ped.14444?af=R
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