Efficacy and safety of deferoxamine, deferasirox and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a protocol for randomised controlled clinical trial

• Published in: BMJ open 2024-02, Vol.14 (2), p.e077342-e077342
• Main Authors: Premawardhena, Anuja, Perera, Chamodi, Wijethilaka, Muditha Nayana, Wanasinghe, Sakuni Keshani, Rajakaruna, R H M G, Samarasinghe, R A N K K, Williams, Senani, Mettananda, Sachith
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; anaemia; Benzoates - adverse effects; Benzoates - therapeutic use; beta-Thalassemia - complications; beta-Thalassemia - drug therapy; Blood diseases; Blood tests; Blood transfusions; Clinical trials; Combination therapy; Compliance; Creatinine; Deferasirox - therapeutic use; Deferiprone - therapeutic use; Deferoxamine - therapeutic use; Haematology (incl blood transfusion); haematopathology; Heart; Hepatitis; Humans; Iron; Iron - therapeutic use; Iron Chelating Agents - adverse effects; Iron Overload - blood; Iron Overload - drug therapy; Iron Overload - etiology; Liver; other metabolic, e.g. iron, porphyria; Patients; Pyridones - administration & dosage; Randomized Controlled Trials as Topic; Teaching hospitals; Triazoles - adverse effects
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-077342

IntroductionDespite the improvement in medical management, many patients with transfusion-dependent β-thalassaemia die prematurely due to transfusion-related iron overload. As per the current guidelines, the optimal chelation of iron cannot be achieved in many patients, even with two iron chelators at their maximum therapeutic doses. Here, we evaluate the efficacy and safety of triple combination treatment with deferoxamine, deferasirox and deferiprone over dual combination of deferoxamine and deferasirox on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.Methods and analysisThis is a single-centre, open-label, randomised, controlled clinical trial conducted at the Adult and Adolescent Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomised into intervention or control groups. The intervention arm will receive a combination of oral deferasirox, oral deferiprone and subcutaneous deferoxamine for 6 months. The control arm will receive the combination of oral deferasirox and subcutaneous deferoxamine for 6 months. Reduction in iron overload, as measured by a reduction in the serum ferritin after completion of the treatment, will be the primary outcome measure. Reduction in liver and cardiac iron content as measured by T2* MRI and the side effect profile of trial medications are the secondary outcome measures.Ethics and disseminationEthical approval for the study has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (Ref. P/06/02/2023). The trial results will be disseminated in scientific publications in reputed journals.Trial registration numberThe trial is registered in the Sri Lanka Clinical Trials Registry (Ref: SLCTR/2023/010).