Summary of findings 2. Summary of findings: Comparison 2 ‐ deferasirox (DFX) versus deferiprone (DFO).
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Intervention: DFX Comparison: DFO | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with DFO | Risk with DFX | |||||
| Adherence to iron chelation therapy (%, SD) | See comments. | 452 (3 RCTs) | ⨁◯◯◯ Very lowa,b | 3 RCTs (n = 452) reported adherence, although 2 of these could not be analysed (Hassan 2016, n = 60; and Vichinsky 2007, n = 195). All 3 RCTs reported no significant difference between groups. | ||
| SAEs Thalassaemia‐related SAEs | DFO: 83 per 1000 DFX: 79 per 1000 (34 to 179) |
RR 0.95 (0.41 to 2.17) | 247 (2 RCTs) | ⨁◯◯◯ Very lowa,b | Zero cases reported in one RCT (n = 60, Hassan 2016), so data are based on a single trial (n = 187, Pennell 2014). | |
| SAEs SCD‐related SAEs |
1 RCT (n = 195) reported SCD‐related AEs as "pain crisis" and "other", so no overall estimate of effect (subtotals calculated using 99% CI) |
— | 195 (1 RCT) | ⨁◯◯◯ Very lowa,b | Data for sub‐outcome "pain crisis", and sub‐outcome "other", are presented in the main text, but we are unable to combine these data as there may be double‐counting; we have therefore not presented the summary statistic in the SoF table. Sub‐outcomes are presented using 99% CI instead of 95% CI. |
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| All‐cause mortality | 8 per 1000 | 8 per 1000 (1 to 128) | POR 0.96 (0.06 to 15.42) | 240 (2 RCTs) | ⨁◯◯◯ Very lowa,b | Both RCTs reporting this outcome were in people with thalassaemia only; zero cases in 1 RCT. |
| Sustained adherence | See comments. | — | — | Sustained adherence is reported as adherence since all studies were longer than 6 months and only reported end of study adherence. | ||
| QoL | Not reported. | — | — | — | ||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AE: adverse event; CI: confidence interval; DFO: deferiprone; DFX: deferasirox; POR: Peto odds ratio; QoL: quality of life; RCT: randomised controlled trial; RR: risk ratio; SAE: serious adverse event; SD: standard deviation; SoF: summary of findings | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
Explanations
aWe downgraded the certainty of evidence twice due to high or uncertain risk of bias in several domains.
bWe downgraded the certainty of evidence once due to imprecision as the CIs are wide and there is only one study with data in the comparison.