Abstract:
Background The efficacy of cardiac iron chelation in transfusion-dependent patients has been demonstrated in one-year prospective trials. Since normalization of cardiac T2* takes several years, the efficacy and safety of deferasirox was assessed for two years in patients with β-thalassemia major in the cardiac sub-study of the EPIC trial. Design and Methods Eligible patients with myocardial T2* greater than 5 to less than 20 ms received deferasirox, with the primary endpoint being the change in T2* from baseline to two years. Results Baseline myocardial T2* was severe (5 to 10 ms) in 39 patients, and moderate-to-mild (10 to 20 ms) in 62 patients. Mean deferasirox dose was 33.1±3.7 mg-kg-d in the one-year core study increasing to 36.1±7.7 mg-kg-d during the second year of treatment. Geometric mean myocardial T2* increased from a baseline of 11.2 to 14.8 ms at two years (P0.001). In patients with moderate-to-mild baseline T2*, an increase was seen from 14.7 to 20.1 ms, with normalization (≥20 ms) in 56.7percent of patients. In those with severe cardiac iron overload at baseline, 42.9percent improved to the moderate-to-mild group. The incidence of drug-related adverse events did not increase during the extension relative to the core study and included (≥5percent) increased serum creatinine, rash and increased alanine aminotransferase. Conclusions Continuous treatment with deferasirox for two years with a target dose of 40 mg-kg-d continued to remove iron from the heart in patients with β-thalassemia major and mild, moderate and severe cardiac siderosis. © 2011 Ferrata Storti Foundation.