Combination Deferasirox and Deferiprone for Severe Iron Overload in Thalassemia

NCT ID: NCT01709032

Last Updated: 2019-03-06

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 9 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2012-09-30
• Study Completion Date: 2017-08-01

Brief Summary

We hypothesize that the combination treatment with deferasirox and deferiprone will be well tolerated and will result in significant improvement in cardiac and liver iron levels.

Detailed Description

Death and disability from iron related damage to the heart remain the most serious issue facing transfusion-dependent patients with thalassemia. However, over the past decade there have been several reports of improved survival and fewer cardiac complications. This improvement may be related to the availability of three chelators and also the accurate measurement of iron stores in various organs (e.g. heart and liver) with magnetic resonance imaging, which allows for personalized, tailored medical care for patients. The chelator characteristics, side effect profiles, and ability to remove iron from specific organs differ among the chelators, suggesting that combination therapy may be beneficial. Using two drugs at lower doses may be more tolerable than escalating doses of a single drug and may improve iron removal. The combination of deferoxamine and deferiprone has been shown to be particularly beneficial for reducing cardiac iron, but it requires a painful injection/infusion, which hinders adherence. This pilot study aims to investigate the safety of an oral-only combination chelator regimen (deferasirox and deferiprone) in individuals with thalassemia major with poorly controlled iron overload and to assess how well this chelator combination lowers iron stores over one year.

Conditions

Thalassemia Major With Severe Transfusional Iron Overload

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Deferasirox and deferiprone

Group Type: EXPERIMENTAL

Deferasirox and deferiprone

Intervention Type: DRUG

Interventions

Deferasirox and deferiprone

Intervention Type: DRUG

Other Intervention Names

Exjade; Ferriprox

Eligibility Criteria

Inclusion Criteria

• Alpha or beta thalassemia
• Receiving chronic transfusions (at least 20 transfusions in lifetime) with iron overload requiring treatment with chelation
• Serum ferritin >500 ng/ml
• Liver iron concentration equal to or greater than 10 mg/g dw (by R2 MRI) or 7 to 10 mg/g dw (by R2 MRI) and not improving OR cardiac T2* between 6 and <20 ms
• Women of childbearing age must have a negative pregnancy test
• Agree to use approved method of contraception for the duration of the study
• Subjects must have a good understanding of the study and be willing to comply with study procedures

Exclusion Criteria

• Subjects with past history of unexplained neutropenia (ANC < 1500/mcL), clinically significant renal disease (creatinine above the upper limit of normal), proteinuria >300 mg/L, clinically significant liver disease (ALT > 5x upper limit of normal), pulmonary or cardiovascular disease
• History of other clinically relevant oral, endocrine, neurologic, psychiatric, immunologic, bone marrow or skin disorder that contraindicates dosing with deferasirox or deferiprone
• History of adverse reaction or known allergy to either deferasirox or deferiprone necessitating drug discontinuation
• Currently receiving treatment for active hepatitis
• Use of any investigational agent in the past 30 days
• Cardiac T2* <6 ms, left ventricular ejection fraction < 56%, and/or arrhythmia (certain subjects may be eligible if they have already had a trial of deferoxamine and deferiprone). Subjects who refuse to use deferoxamine after extensive consultation with at least 2 health care providers will also be allowed to participate.
• Pregnant or breastfeeding females
• Unwilling or unable to comply with study related procedures

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Cooley's Anemia Foundation,

OTHER

Sponsor Role: collaborator

Ann & Robert H Lurie Children's Hospital of Chicago

OTHER

Sponsor Role: collaborator

Children's Hospital of Philadelphia

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Janet L Kwiatkowski, MD, MSCE

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Philadlephia

Locations

Ann & Robert H. Lurie Children's Hospital of Chicago

Chicago, Illinois, United States

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Countries

United States

Other Identifiers

12-009449

Identifier Type: -

Identifier Source: org_study_id