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Recent insight on improving the iron chelation efficacy of deferasirox by adjuvant therapy in transfusion dependent beta thalassemia children with sluggish response

Expert Opin Drug Metab Toxicol. 2020 Mar;16(3):179-193 doi: 10.1080/17425255.2020.1729353.
PICO Summary
POPULATION:

Transfusion dependent beta thalassemia children with sluggish response (n=160).

INTERVENTION:

Group I 30 mg/kg deferasirox. (n=40).

COMPARISON:

Group II 20 mg omeprazole and 30 mg/kg deferasirox (n=40); group III 400 mg vitamin E and 30 mg/kg deferasirox (n=40); group IV 420 mg silymarin and 30 mg/kg deferasirox (n=40).

OUTCOME:

Silymarin, Vitamin E and omeprazole significantly increased the peak plasma concentration of deferasirox by 27.9, 14.9 and 2.4 fold respectively as compared to deferasirox alone. The bioavailability of deferasirox was improved up to 3.03, 3.57 and 4.98-fold, respectively, following administration of omeprazole, vitamin E and silymarin compared to deferasirox alone.

Abstract

Background: Deferasirox is the first line of treatment in iron overload. In spite of the many studies concerning the efficacy of deferasirox, some patients remain unresponsive to deferasirox.Methods: One hundred and sixty patients were enrolled in stratified-randomized controlled study. Patients were randomly divided into four regimens, group I (n = 40) received 30 mg/kg deferasirox, group II (n = 40) received 20 mg omeprazole and 30 mg/kg deferasirox, group III (n = 40) received 400 mg vitamin E and 30 mg/kg deferasirox and group IV (n = 40) received 420 mg silymarin and 30 mg/kg deferasirox. Blood specimens were collected from each patient for up to 24 h, and then plasma deferasirox concentrations were inspected.Results: Silymarin, Vitamin E, and omeprazole significantly increased the peak plasma concentration of deferasirox (P < 0.001) by 27.9, 14.9 and 2.4 fold, respectively, as compared to deferasirox alone. The bioavailability of deferasirox was improved up to 3.03, 3.57, and 4.98-fold, respectively, following administration of omeprazole, vitamin E, and silymarin compared to deferasirox alone.Conclusion: Silymarin, vitamin E, and omeprazole represent promising adjuvant therapy to improve the chelation efficacy of deferasirox that might also be further applied to enhance the pharmacokinetics of deferasirox to overcome the lack of response.

Metadata
KEYWORDS: Deferasirox; pharmacokinetic; silymarin; thalassemia Major; vitamin E
MESH HEADINGS: Adolescent; Blood Transfusion; Child; Combined Modality Therapy; Deferasirox; Drug Therapy, Combination; Female; Humans; Iron Chelating Agents; Male; Omeprazole; Treatment Outcome; Vitamin E; beta-Thalassemia
Study Details
Study Design: Randomised Controlled Trial
Language: eng
Credits: Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine