Comparative efficacy of deferrioxamin and combination of deferiprone and deferrioxamine on echocardiographic indices in beta thalassemic patients

Regular blood transfusions in beta thalassemic patients can lead to accumulation of extra iron in the body which may result in cardiac complications and death. Deferrioxamin (DFO) is the standard treatment for this condition but 12-8 hours subcutaneous (SQ) injection of this drug per day can cause local pain which together with lack of patients´ compliance, it is necessary to use another drug to improve the condition of the patients. Deferiprone (DFP), is an approved drug for this purpose and removes iron from cells including cardiac muscle cells. The aim of this study is to compare efficacy of deferrioxamin with that of combined deferiprone and deferrioxamin on echocardiographic indices in beta thalassemic patients. In this randomized clinical trial 40 thalassemic patients who met the inclusion criteria of this study were divided into two equal groups. Controls group received SQ deferrioxamin for six days/week and intervention group received deferrioxamin for three days/week and deferiprone orally for four days/week. Cardiac indices were measured and compared before and after the study. Mean values of the age of the patients were 15.6±5.1 and 14.1±6 years in the intervention and control group respectively. Right ventricle diameter (RVD) indices in control group was 18.7±7.6 and 20.8±6.6 mm before and after treatment respectively (P<0.05). In the intervention group RVD indices were 19.5±5.8 and 18.0 ±4.7 mm before and after treatment respectively (P>0.05). Other indices such as LVEDD, LVESD, aortic root diameter, EF and Fs of left ventricle and also indices of the heart valves revealed no significant differences between the two groups. We didn’t observe any side effect of the drugs in the patients. We concluded combined therapy with 4 days DFP and 3 days DFO per week did not lead to cardiac complications and deterioration of echocardiographic indices.