Deferiprone for transfusional iron overload and its roles in developing countries

Abstract

Introduction: Variations in chelation efficacy and adverse events in particular neutropenia and agranulocytosis relegate deferiprone (DFP) to a second-line therapy in iron overload patients in whom iron chelation with deferoxamine (DFO) is inadequate. With a major economical constraint, many patients who have no access to DFO or deferasirox in developing countries have started to use DFP as their first option. It is of interest to review the clinical pharmacology and latest clinical experiences with DFP to determine its role in the developing world. Areas covered: This review describes the preclinical and clinical data of DFP in patients with transfusional iron overload by searching with the keywords 'deferiprone' and 'iron overload' using the PubMed database. A projection of iron chelation cost per year was estimated based on the market price of all available iron chelators in 2013 and expected number of thalassemia patients who require chelation therapy in Thailand as an example. Expert opinion: Through a comprehensive program of medical education and continuous monitoring with appropriate clinical guidelines, DFP can be used with acceptable efficacy and safety. In patients who do not respond well to DFP monotherapy and/or require intensive chelation due to cardiac iron overload, a combination of DFP and DFO is highly recommended. © Informa UK, Ltd.