Beruflich Dokumente
Kultur Dokumente
Afiliasi/ Institusi
Winaya Waidya Anarawata (WWA) 8 Rumah sakit
Univeristas Asal
Pendidikan Kedokteran Berkelanjutan
IDAI DI Yogyakarta – Departemen IKA FK UGM
Periode Juli 2016
OUT LINE
• Splenomegaly* • Thrombosis*
• Pulmonary hypertension*
• Leg ulcers (rare)*
• Right heart failure*
• Growth retardation*
• Gallstones*
• Skeletal abnormalities*
• Infections*
• Renal abnormalities†
• Hepatocellular carcinoma
• Iron overload complications • Folic acid deficiency
• Jaundice • Acute hemolytic episodes
RCT I :
– Deferipone (92mg/kgbb/day) vs deferoxamin (43mg/kgbb/day) for
5,7 day/week
– Result:
• Improvement:
– T2* Deferiprone > deferoxamin (27% vs 13%, P =0,023)
– LVEF Deferipron > deferoxamin (3,1%:0,3% absolut unit, P
=0,003)
– This RCT established that deferiprone was superior to deferoxamine
over 1 year for the removal of cardiac iron, and the improvement
of LV EF in patients with asymptomatic myocardial siderosis
RCT II:
– (Deferiprone+deferoxamine) vs deferoxamine
– 65 patients with myocardial T2∗ from 8 to 20 ms
•Results:
– Improvement T2* (Deferiprone+deferoxamine) > deferoxamine
(ratio of change in geometric means +50% versus +24%; P = 0.02).
– The combined group also showed significantly great improvement in
absolute LV EF (2.6% versus 0.6%; P = 0.05), and absolute
endothelial function (8.8% versus 3.3%; P = 0.02)
RCT II:
– (Deferiprone+deferoxamine) vs deferoxamine
– 65 patients with myocardial T2∗ from 8 to 20 ms
•Results:
– Improvement T2* (Deferiprone+deferoxamine) > deferoxamine
(ratio of change in geometric means +50% versus +24%; P = 0.02).
– The combined group also showed significantly great improvement in
absolute LV EF (2.6% versus 0.6%; P = 0.05), and absolute
endothelial function (8.8% versus 3.3%; P = 0.02)
Baksi &Pennell, Frontier & Pharmacology;September 2014: Volume 5: Article 217 :1
RCT OF IRON CHELATORS FOR THE TREATMENT OF CARDIAC SIDEROSIS IN
THALASSEMIA MAJOR
RCT III:
•Deferasirox (target dose 40 mg/kg per day) vs deferoxamine (50– 60 mg/kg per day for 5–7
days/week)
•Aprospective, randomized in myocardiac patients (T2∗ 6–20 ms) and no signs of cardiac
dysfunction.
•Result:
TABLE I SERUM FERRITIN VALUES AT THE START, AT 6 MONTHS AND AT 12 MONTHS IN STUDY PARTICIPANTS
__
Bhandari & Galanello,2012; European Journal of Haematology 89 (187--197)
ADHERENCE TO CHELATORS
88%
Kwiatkowski
thalassemia reported by
Deferasirox et al 2012
patients
FACTORS INFLUENCING PATIENT ADHERENCE