Single-Centre, North American Experience with Compassionate Use of Deferiprone in Patients with Beta-Thalassemia Major,
Notice bibliographique
Résumé
Abstract Abstract 3185 Introduction: Deferiprone (DFP) is a thrice daily, oral iron chelator with cardiac-specific properties. It has been demonstrated to improve LV EF% and reduce cardiac related morbidity and mortality in patients with Beta Thalassemia Major (TM). It was approved as second line therapy by European regulatory agencies in 1999, but despite being developed by a Toronto-based pharmaceutical company, has yet to be approved by Health Canada or the FDA. Since July 2004 it has been available via a compassionate use program (CUP). The Red Blood Cell Disorders Program (RBCDP, Toronto General Hospital, Canada) is Canada's largest adult Hemoglobinopathy comprehensive care centre. In mid 2009, the RBCDP took a programmatic decision to systematically enrol those patients with significant cardiac siderosis, and hence at risk of cardiac events and death, in the CUP. Patients intolerant of or having a suboptimal responsive to Deferoxamine or/and Deferasirox were also considered for DFP therapy. Here we report on a single centre experience with this oral chelator within a North American healthcare system. Methods: Approval was received from the Research Ethics Board and data was collected retrospectively from the RBCDP database, electronic patient records, and CUP monitoring records. Patients complied with weekly CBC monitoring through the use of community based laboratories with electronic transmission of results in a timely manner. All patients who were prescribed DFP for at least 12 months between January 2009 and January 2011 were included in the analysis. Efficacy data and adverse events are reported here. Results: Thirty-four patients were identified (19 females and 15 males; 29 beta-Thalassemia Major, 4 Hemoglobin E/b-Thalassemia compound heterozygote, 1 homozygous sickle cell disease) for a total of 28.72 patient-years observed. 2 patients were excluded from analysis due to incomplete data. Nineteen patients (58%) were splenectomised. Mean age at the start of DFP therapy was 31.07 years (SEM +/− 5.18 years). 16 patients received DFP in combination with another chelator. 22/34 were prescribed DFP for severe cardiac siderosis. Sixteen (48%) of the patients were prescribed at 75 mg/kg/day and 17 (52%) at 100 mg/kg/day. Mean physician-assessed adherence rate was 68% (SEM +/− 12%), with 64% of patients having >90% adherence rate. Serial T2* and ejection fraction (EF) measurements from cardiac MRI were available in 22 patients, with a mean change in T2* of +2.6 ms/year (SEM +/− 0.5 ms/year) and EF +1.5%/year (SEM +/− 0.3%/year). There was a significant change in T2* measurements after an average of 425 days (SEM +/− 91 days) of DFP therapy (P=0.0006). No significant change was observed in LIC (−2.84 mg/g dry weight; P = 0.067) or ferritin values (542.6 umol/L; P=0.327). Neutropenia (ANC < 1.5) was observed in 4 patients totalling 11 instances but no agranulocytosis was observed. Four patients had an asymptomatic transient increase in alanine transferase (> 5x upper limit of normal). Four patients had arthralgias, which resolved with dose reduction. Discussion: We believe that the RBCDP currently has the largest active population of patients receiving chelation with DFP in North America. Initial data presented here demonstrates the drug to be effective in controlling cardiac iron overload; is well tolerated; and reveals no new adverse effects. Our experience mirrors that of Thalassemia centres outside of North America over the past 10 years. Longer follow up of this cohort is ongoing. Disclosures: Off Label Use: Deferiprone is an unlicensed medication in USA and Canada, and is available through compassionate use. It is an oral iron chelator. Kuo:Novartis Canada: Research Funding.
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».