To the Editor:

In a note added in proof to their excellent review on iron chelation, Olivieri and Brittenham1 updated your readers on two abstracts recently presented by them to suggest that deferiprone may not provide adequate control of body iron in a substantial proportion of patients with thalassemia major. Because reviews aim at allowing the reader a ballanced view on an issue, it is of importance to inform your readership that the same data have been interpreted differently2-4 by other investigators involved in these studies.

More work is needed before one can conclude on the relative efficacy and effectiveness of deferiprone as compared with deferrioxamine, as well as on the mechanisms of variability in its response. For example, it has been shown that more sustained administration of deferiprone induces higher iron excretion,5 and the development of sustained release formulation should be considered.

Future studies should also address potential combinations of deferiprone with deferrioxamine in patients exhibiting poor compliance or severe toxicity with desferroxamine. It is worth remembering that it took almost 15 years between the introduction of deferrioxamine and the establishment of an effective way to deliver it to chronically iron overloaded patients.

REFERENCES

REFERENCES
1
Olivieri
NF
Brittenham
GM
Iron-chelating therapy and the treatment of thalassemia.
Blood
89
1997
739
2
Diav-Citrin O, Atanackovic G, Loebstein R, Koren G: Investigation of variability in response to deferiprone in patients with beta-thalassemia major. Clin Pharmacol Ther 61:146, 1997 (abstr)
3
Tricta F, Dougherty G, Diav-Citrin O, Loebstein R, Atanackovic G, Koren G: Randomized trial of deferiprone and deferoxamine in thalassemia major. Proceedings of the 6th International Conference on Thalassemia and the Hemoglobinopathies. The Thalassemia International Federation, Malta, April 5-10, 1997, p 330
4
Tricta F, Sher G, Loebstein R, Atanackovic G, Diav-Citrin O, Koren G: Long term chelation therapy with the orally active iron chelator deferiprone in patients with thalassemia major. Proceedings of the 6th International Conference on Thalassemia and the Haemoglobinopathies. The Thalassemia International Federation, Malta, April 5-10, 1997, p 220
5
Fassos
F
Klein
J
Fernandes
D
Matsui
D
Olivieri
N
Koren
G
Urinary iron excretion depends on the mode of administration of the oral iron chelation 1,2 dimethyl 3-hydroxypyrid-0-one in homozygous beta thalassemia patients.
Clin Pharmacol Ther
55
1994
70