Study With Deferiprone and/or Desferrioxamine in Iron Overloaded Patients
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|ClinicalTrials.gov Identifier: NCT00350662|
Recruitment Status : Completed
First Posted : July 11, 2006
Last Update Posted : November 19, 2012
|First Submitted Date ICMJE||July 10, 2006|
|First Posted Date ICMJE||July 11, 2006|
|Last Update Posted Date||November 19, 2012|
|Study Start Date ICMJE||January 2002|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE
||Clinical efficacy (Iron balance and liver iron concentration) [ Time Frame: At baseline and at 12 months ]|
|Original Primary Outcome Measures ICMJE
||Clinical efficacy (Iron balance and liver iron concentration) at 12 months|
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE
|Current Other Pre-specified Outcome Measures||Not Provided|
|Original Other Pre-specified Outcome Measures||Not Provided|
|Brief Title ICMJE||Study With Deferiprone and/or Desferrioxamine in Iron Overloaded Patients|
|Official Title ICMJE||Randomized Open-label Phase III Study With Deferiprone and/or Desferrioxamine in Iron Overloaded Patients|
|Brief Summary||Comparison of efficacy and toxicity of the combination treatment of deferiprone and desferrioxamine with the single agent treatment of either drug|
Patients with refractory anemias requiring regular blood transfusions accumulate iron at the rate of approximately 0.5 mg/kg/day, which may lead to serious organ toxicity. The human body has no active mechanism for the excretion of excess iron. Therefore multiply transfused patients will develop a secondary hemosiderosis, if no iron excretion is achieved by a chelating agent. Symptoms of iron-overload occur when body iron stores reach 10-20 g. At higher levels severe, even fatal complications, particularly cardiac failure, may develop.
Desferrioxamine (DFO, Desferal) is the established and commonly used iron-chelating drug, but is expensive and must be given by slow subcutaneous or intravenous infusion for 8-12 hours a day during 5-7 days weekly at a dosage of 40-50mg/kg body weight/day. This often leads to failure of compliance of the patient and therefore to inefficient iron chelation. Further some patients are hypersensitive to desferrioxamine and others suffer from toxicity, e.g. to the ears or eyes.
Deferiprone (L1; CP20; 1,2 dimethyl-3-hydroxy-pyrid-4-one) is an orally active iron chelator investigated in various clinical trials since 1987. Dosages of 75 - 100mg/kg body weight/day of L1 have been found effective to maintain stable iron balance (urinary iron excretion of 0.5mg/kg/day) and to reduce serum ferritin levels between 6% and 25% within one year of treatment in iron-overloaded thalassemic patients. There exists long-term experience with patients who have received deferiprone continuously for more than 10 years so far. However, only few controlled comparison studies with L1 and DFO have been performed so far in order to confirm the effectiveness of deferiprone.
The main side effects encountered during a deferiprone therapy are arthropathy, gastrointestinal symptoms, headache, and mild zinc deficiency. These adverse effects are usually reversed on reducing the dose or discontinuing the drug. Except for severe joint symptoms in few patients, most of the subjects in different clinical trials have been able to continue with L1 therapy for a long-term. The most severe and rare complication following L1 administration is agranulocytosis or neutropenia.
A new treatment regimen by combining deferiprone with desferrioxamine is currently being investigated in many countries. Preliminary data could demonstrate that the combined use of both drugs is highly active showing a synergistic or even additive effect (significant decrease of serum ferritin and hepatic iron content, increase of urinary iron excretion). This synergism could be explained by the different mode of activity of the two drugs. It could be demonstrated that patients who were not sufficiently chelated with desferrioxamine or deferiprone, could achieve a negative iron balance with the combination treatment of both drugs. The combined regimen was generally well-tolerated and there is evidence that the individual toxicity profile of both drugs can be positively influenced by the simultaneous administration of L1 and DFO. The daily treatment with L1 tablets combined with a twice a week administration of parenteral desferrioxamine is more patient-convenient and therefore may enhance the compliance of the patient. In addition, this new treatment regimen will reduce the overall therapy expenses if compared to the high Desferal and material costs related to the parenteral administration of DFO on 5 to 7 days per week.
The results of the previous studies with deferiprone are often not comparable, e.g. laboratory parameters, toxicities and side effects vary from study to study. The number of patients included in the clinical investigations was in general too low to allow statistically significant evaluations. Further, there is no controlled randomized study comprising an appropriate number of patients in order to allow a comparison between the combination arm and the single agent control arms. This study protocol aims to evaluate the feasibility of the combination treatment by comparing the efficacy and safety of the combined drugs with the single agent treatment of L1 and DFO in iron-overloaded patients with thalassemia or refractory anemia in a controlled randomized multicenter study.
|Study Type ICMJE||Interventional|
|Study Phase ICMJE||Phase 3|
|Study Design ICMJE||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Study Arms ICMJE||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Completed|
|Actual Enrollment ICMJE
|Original Enrollment ICMJE||Same as current|
|Study Completion Date ICMJE||Not Provided|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
|Ages ICMJE||4 Years and older (Child, Adult, Older Adult)|
|Accepts Healthy Volunteers ICMJE||No|
|Contacts ICMJE||Contact information is only displayed when the study is recruiting subjects|
|Listed Location Countries ICMJE||Egypt, Turkey|
|Removed Location Countries|
|NCT Number ICMJE||NCT00350662|
|Other Study ID Numbers ICMJE||DF-1|
|Has Data Monitoring Committee||No|
|U.S. FDA-regulated Product||Not Provided|
|IPD Sharing Statement ICMJE||Not Provided|
|Study Sponsor ICMJE||Lipomed|
|Collaborators ICMJE||Not Provided|
|Verification Date||November 2012|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP