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Indian Pediatr 2012;49: 682
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Deferiprone is Superior to Deferasirox and
Desferrioxamine in Cardiac Iron Overload
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Mamta V Manglani
Professor & Head, Department of Pediatrics, LTM
Medical College & General Hospital, Sion, Mumbai 400 022.
Email:
[email protected]
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In response to a recent editorial published in Indian Pediatrics [1], I
have following comments to offer.
The editorial addresses issues of cardiac iron
overload in thalassemic patients and mentions that "Although
quantitative liver iron measurement accurately guides the use of iron
chelators, it may not reflect cumulative changes in cardiac iron.
Thalassemics may have cardiac iron overload even at the time of a safe
liver iron measurement". This is contradicted in the next paragraph
quoting another reference as follows: "An increased risk of iron-induced
cardiac disease is observed with liver iron concentration (LIC) values
above 15 mg of iron per gram of dry weight of liver, and in patients
with serum ferritin values above 2500 microgram/liter." There is new
evidence to suggest that neither serum ferritin nor liver iron
concentration correlate with cardiac iron, and therefore, T2* weighted
cardiac magnetic resonance imaging is currently being considered as the
gold standard for evaluating cardiac iron overload in thalassemics [2].
Additionally, reference 6 of the article is
misquoted: the study by Pepe, et al. in Hematologica 2011 states
clearly in its conclusion that "the cohort of patients treated with oral
deferiprone showed less myocardial iron burden and better global
systolic ventricular function compared to the patients treated with oral
deferasirox or subcutaneous desferrioxamine." Moreover, the study was
performed on 115 patients [3]. The author has quoted as follows:
"Further, efficacy of available chelators on myocardial iron and
biventricular function by quantitative MRI in 550 thalassemics concluded
that oral deferasirox has better global systolic ventricular function
compared to oral deferiprone and subcutaneous desferoxamine [1]". This
is misleading to the readers of the journal.
References
1. Gaur A. Thalassemia: Cardiac iron and chelators.
Indian Pediatr. 2012;49:268-9.
2. Kirk P, Roughton M, Porter JB, Walker JM, Tanner
MA, Patel J, et al. Cardiac T2* Magnetic resonance for prediction
of cardiac complications in thalassemia major. Circulation.
2009;120:1961-8.
3. Pepe A, Meloni A, Capra M, Cianciulli P,
Prossomariti L, Malaventura C, et al. Deferasirox, deferiprone
and desferrioxamine treatment in thalassemia major patients: cardiac
iron and function comparison determined by quantitative cardiac magnetic
resonance imaging. Haematologica. 2011;96:41-7.
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