The ideal management of transfusion-dependent thalassemia requires a multidisciplinary therapeutic approach. Studies from the UK show that approximately 50% of transfusion-dependent thalassemia patients die before age 35 due to non-adherence to routine iron chelation therapy. Thus, improving adherence to iron chelation is the most effective way to reduce transfusion-dependent morbidity and mortality in thalassemic patients.
A prospective, single-arm study assessed adherence to iron chelation therapy, causes of non-adherence to iron chelation therapy, and its effects on secondary complications of iron overload. The included patient was transfusion-dependent thalassemia with iron chelation therapy for> 6 months. A questionnaire was used to collect information on adherence to iron chelation therapy and possible causes of non-adherence.
The results of this study are: (n = 215)
• The mean age of the patients was 15.07 ± 7.68 years.
• Iron chelation alone was administered in 57.2% of patients and a combination of 2 or more was administered to 42.7% of patients. Deferasirox is the most commonly administered iron chelate.
• Adherence tended to be the best with deferasirox (91.2%) followed by deferiprone (87.2%) and deferoxamine (83.3%).
• Non-adherence to iron chelation therapy was found in 10.7% of patients.
• Serum ferritin levels were significantly higher in the non-adherent group than in the adherent group.
• Excess iron in the heart and liver (which is severe) is more common in patients who are not adherent.
• There is no correlation between knowledge of disease and adherence to iron chelation therapy.
• Reasons for non-adherence to iron chelation therapy were difficulty administering the drug and the number of medicine taken per day.
• There was no difference in comorbidities due to iron overload in the adherent and non-adherent groups.
This study concludes is that there is a link between adherence to iron chelation and iron overload status in transfusion-dependent thalassemia patients. Adherence to iron chelation therapy tends to be best with deferasirox.
Image : Ilustration
Reference:
1. Sidhu S, Kakkar S, Dewan P, Bansal N, Sobti PC. Adherence to iron chelation therapy and its determinant. Int J Hematol Oncol Stem Cell Res. 2021; 15 (1): 27-34.
2. Porter B, Evangeli M, El-Beshlawy A. Challenges of adherence and persistence with iron chelation therapy. Int J Hematol. 2011; 94 (5): 453-60.
