Effect of deferasirox therapy on serum ferritin level and its side effect in Iraqi thalassemia patients

Abstract

Deferasirox is an iron chelating drug of oral intake. It is main use is to decrease iron overload in patients who are receiving blood transfusions for a long time in conditions such as beta-thalassemia and other chronic anemias. This study was aimed to determine the benefit of the oral chelating agent (Deferasirox) and it is a side effect in thalassemia patients. Fifty patients with a provisional diagnosis of thalassemia major and transfusional iron in Aldiwaniya province /Iraq in the period (August 2015–April 2017). Most of the patients were managed according to the own protocol with the target hemoglobin levels around 9.5-10.5 mg/dl before blood transfusion. Serum ferritin estimation was advised after at least ten packed red cell transfusions. The oral chelating was started to inform of deferasirox oral tablet in doses of 10 to 20 mg per kg per day if ferritin levels in serum reached > 1000 ng per ml and 20- 40mg/kg if serum ferritin more than 1500ng/ml. Those patients were switched to deferasirox, as an oral chelating agent without used any other chelator. The patients were classified based on the age groups (less than and above 10 years) and according to gender. The average level of ferritin in the serum of these group at the initiation of the study was 2678.83 ng/ml before treatment and 2255.43ng/ml after deferasirox commenced. The study group recorded a good compliance in 70% and poor in 30%. Patients treated with deferasirox showed some gastrointestinal symptoms like abdominal cramps, vomiting, and diarrhea in 12% of cases and skin rash in 2% and increase in a liver enzyme in 4%. Deferasirox is well affordable with long-term treatment and the adverse effects are minimal with this medication; therefore optimum treatment is needed to produce the good clinical result and decrease or no adverse effects in a good acceptable dose; however the occurrence of therapy-related adverse effect decreases with time and the common therapeutic complications reported are related to gastrointestinal symptoms and skin rash in some patients and increase in liver enzyme. The availability of this therapy (oral iron chelators), like deferasirox, may take part to produce good satisfaction, especially among young child and school-age patients in which the compliance is a very big problem.