Table I.
Overview of iron chelators.
| Property | Deferoxamine | Deferiprone | Deferasirox |
|---|---|---|---|
| Stoichiometry (chelator:iron) | Hexadentate (1:1) | Bidentate (3:1) | Tridentate (2:1) |
| Route | Subcutaneous, intravenous | Oral tablet or solution | Tablets for oral suspension |
| Usual dose | 20–40 mg/kg/day over 8–24 hours, 5 days/week | 75–100 mg/kg/day in 3 divided doses daily | Recommended initial dose 20 mg/kg up to a maximum of 40 mg/kg/day |
| Excretion | Urinary, faecal | Mainly urinary | Faecal |
| Half-life | 20–30 min | 3–4 hours | 8–16 hours |
| Adverse effects | Local skin reactions Ophthalmological Auditory Allergic reactions Growth retardation Bone abnormalities Pulmonary at high doses Neurological at high doses |
Gastrointestinal Agranulocytosis/neutropenia Arthralgia Elevated liver enzymes |
Gastrointestinal Rash Rise in creatinine Proteinuria Ophthalmological Auditory Elevated liver enzymes |
| Challenges | Adherence due to parenteral administration; need for yearly ophthalmology and audiometric examination | Need for weekly blood count monitoring; not commercially available in all countries; limited data in children; variable efficacy in removal of hepatic iron | Cost, especially with higher doses; gastrointestinal side effects may limit optimal dosing Need for monthly monitoring of creatinine, transaminases, bilirubin, complete blood count for potential renal or hepatic failure and/or gastrointestinal haemorrhage (more frequently in patients with advanced age and existing comorbidities) |
| Status | Licensed | Licensed in USA and Europe | Licensed in USA and Europe |
| Indications | Treatment of chronic iron overload due to transfusion-dependent anaemias (and for treatment of acute iron intoxication) | Treatment of iron overload in thalassemia major when DFO is contraindicated or inadequate. | In USA licensed for the treatment of chronic iron overload due to transfusion-dependent anaemias in individuals aged 2 years and older In Europe licensed for the treatment of transfusional iron overload in beta-thalassaemia major patients, 6 years and older, and approved for use when DFO is inadequate or contraindicated in patients with other anaemias, patients 2–5 years, and patients with non-transfusion-dependent thalassaemia |
| Age considerations | Not recommended for children <3 years with low transfusional burden | Limited or no data on children aged <6–10 years | Studied in children as young as 2 years old |