Iron Overload, Other Anemias, Sickle Cell Disease
Conditions
Keywords
sickle cell disease, Iron overload, Deferiprone, Ferriprox, deferoxamine, Chelation
Brief summary
This research is being done so that we can look at the safety and efficacy of deferiprone in people with sickle cell disease or other anemias. Deferiprone is a drug that removes iron from the body. We will be comparing deferiprone with deferoxamine, another drug that removes iron from the body.
Detailed description
Deferiprone (brand name Ferriprox®) is an iron chelator that is approved in the United States and over 60 other countries for the treatment of iron overload in patients with thalassemia, when other treatments are inadequate. This study has been designed to evaluate the efficacy, safety, and tolerability of deferiprone vs. deferoxamine in patients who have SCD or other anemias, and who require chelation because of the extra iron they are taking in through blood transfusions. About 300 people from North America, South America, Europe, and the Middle East will take part in this study. Participants will be randomized in a 2:1 ratio to receive therapy for 52 weeks with either deferiprone or deferoxamine, another type of iron chelator. Patients who are randomized to the deferiprone group can choose to get the drug as either tablets or liquid, and must take it three times daily. Patients who are randomized to the deferoxamine group will receive it as a subcutaneous infusion that lasts from 8 to 12 hours and is given 5 to 7 days per week. For both drugs, the starting dosage is based on how much extra iron they have taken in through transfusions in the last 3 months and on the severity of iron load, as measured by serum ferritin levels in the blood and by the amount of iron in the liver and the heart. For deferiprone, the starting dosage will be increased each week over the first 3 weeks; and for both drugs, the dosage may be adjusted up or down during the study based on the level of iron overload and on safety considerations. Patients will need to have their blood count checked every week for the first 26 weeks, then every other week for the remaining 26 weeks; they will also have to give a blood sample for more detailed safety testing every month; and to give a blood sample for the measurement of serum ferritin every 3 months. Every six months, they will undergo an ECG and an MRI scan, and will be asked to complete a quality of life survey. At the end of the 52 weeks, participants will be invited to enter a 2-year study in which all patients will receive deferiprone, including those who were randomized to receive deferoxamine in the first year.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
1. Male or female ≥ 2 years of age; 2. Have sickle cell disease (confirmed by Hb electrophoresis or more specific tests) or other conditions with iron overload from repeated blood transfusions (see
Exclusion criteria
for exceptions); 3. Baseline LIC \>7 mg/g dw (measured by MRI); 4. Patients who have received no less than 20 transfusions of RBCs; 5. Patients who have received at least 1 transfusion per year in the last 2 years and who are expected to have a continuing requirement (based on Investigator's judgement) during the duration of the trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Liver Iron Concentration (LIC) | Change from baseline to Week 52 | LIC was measured by MRI. A score \>7 mg/g dw is indicative of iron overload. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Cardiac Iron | Change from baseline to Week 52 | Cardiac iron is measured by MRI in milliseconds (ms). A score of less than 20 ms is indicative of cardiac iron overload. |
| Change From Baseline in Serum Ferritin | Change from baseline to Week 52 | Serum ferritin provides a measure of iron level in the blood. Normal levels of serum ferritin are under 300 µg/L for females and 400 µg/L for males. |
| Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | Change from baseline to Week 52 | Adult patients completed the SF-36 questionnaire and minors completed the CHQ-PF50. These questionnaires yield a profile of functional health and well-being, based on 8 scales of physical and mental health measures: Physical Functioning, Role Limitations due to Physical Health, Bodily Pain, General Health Perceptions, Vitality, Social Functioning, Role Limitations due to Emotional Problems, and Mental Health (MH), and summary scores are produced for physical well-being and mental well-being. The summaries are scored from 0-100, with higher scores reflecting better outcomes. |
Countries
Brazil, Canada, Egypt, Saudi Arabia, Tunisia, Turkey (Türkiye), United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Deferiprone Number of patients who received deferiprone | 152 |
| Deferoxamine Number of patients who received deferoxamine | 76 |
| Total | 228 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 9 | 3 |
| Overall Study | Lost to Follow-up | 4 | 1 |
| Overall Study | Patient stopped dosing on unknown date | 1 | 0 |
| Overall Study | Physician Decision | 1 | 1 |
| Overall Study | Protocol Violation | 11 | 4 |
| Overall Study | Required bone marrow transplant | 0 | 1 |
| Overall Study | Termination of the study | 7 | 3 |
| Overall Study | Withdrawal by Subject | 13 | 7 |
Baseline characteristics
| Characteristic | Deferiprone | Deferoxamine | Total |
|---|---|---|---|
| Age, Continuous | 16.9 years STANDARD_DEVIATION 10.2 | 16.9 years STANDARD_DEVIATION 8.5 | 16.9 years STANDARD_DEVIATION 9.6 |
| Cardiac iron at baseline | 33.52 milliseconds STANDARD_DEVIATION 6.26 | 33.87 milliseconds STANDARD_DEVIATION 6.17 | 33.64 milliseconds STANDARD_DEVIATION 6.22 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 10 Participants | 6 Participants | 16 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 142 Participants | 70 Participants | 212 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Liver iron concentration at baseline | 16.54 mg iron per gram of liver dry weight STANDARD_DEVIATION 7.49 | 15.97 mg iron per gram of liver dry weight STANDARD_DEVIATION 7.2 | 16.26 mg iron per gram of liver dry weight STANDARD_DEVIATION 7.3 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 23 Participants | 14 Participants | 37 Participants |
| Race (NIH/OMB) More than one race | 9 Participants | 6 Participants | 15 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 120 Participants | 56 Participants | 176 Participants |
| Region of Enrollment Brazil | 9 Participants | 7 Participants | 16 Participants |
| Region of Enrollment Canada | 1 Participants | 1 Participants | 2 Participants |
| Region of Enrollment Egypt | 105 Participants | 51 Participants | 156 Participants |
| Region of Enrollment Saudi Arabia | 8 Participants | 3 Participants | 11 Participants |
| Region of Enrollment Tunisia | 6 Participants | 1 Participants | 7 Participants |
| Region of Enrollment Turkey | 1 Participants | 1 Participants | 2 Participants |
| Region of Enrollment United Kingdom | 6 Participants | 5 Participants | 11 Participants |
| Region of Enrollment United States | 16 Participants | 7 Participants | 23 Participants |
| Serum ferritin level at baseline | 4125.4 micrograms per liter STANDARD_DEVIATION 2407.4 | 4055.3 micrograms per liter STANDARD_DEVIATION 2708.5 | 4101.89 micrograms per liter STANDARD_DEVIATION 2505.66 |
| Sex: Female, Male Female | 69 Participants | 38 Participants | 107 Participants |
| Sex: Female, Male Male | 83 Participants | 38 Participants | 121 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 152 | 1 / 76 |
| other Total, other adverse events | 134 / 152 | 67 / 76 |
| serious Total, serious adverse events | 40 / 152 | 14 / 76 |
Outcome results
Change From Baseline in Liver Iron Concentration (LIC)
LIC was measured by MRI. A score \>7 mg/g dw is indicative of iron overload.
Time frame: Change from baseline to Week 52
Population: Intent-to-treat population
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Deferiprone | Change From Baseline in Liver Iron Concentration (LIC) | -4.13 mg of iron per gram of liver dry weight | Standard Error 0.5 |
| Deferoxamine | Change From Baseline in Liver Iron Concentration (LIC) | -4.38 mg of iron per gram of liver dry weight | Standard Error 0.59 |
Change From Baseline in Cardiac Iron
Cardiac iron is measured by MRI in milliseconds (ms). A score of less than 20 ms is indicative of cardiac iron overload.
Time frame: Change from baseline to Week 52
Population: Intent-to-treat population
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Deferiprone | Change From Baseline in Cardiac Iron | -0.022068 milliseconds | Standard Error 0.021133 |
| Deferoxamine | Change From Baseline in Cardiac Iron | -0.021773 milliseconds | Standard Error 0.025261 |
Change From Baseline in Serum Ferritin
Serum ferritin provides a measure of iron level in the blood. Normal levels of serum ferritin are under 300 µg/L for females and 400 µg/L for males.
Time frame: Change from baseline to Week 52
Population: Intent-to-treat
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Deferiprone | Change From Baseline in Serum Ferritin | -385.83 micrograms per liter | Standard Error 234.05 |
| Deferoxamine | Change From Baseline in Serum Ferritin | -760.89 micrograms per liter | Standard Error 289.4 |
Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50).
Adult patients completed the SF-36 questionnaire and minors completed the CHQ-PF50. These questionnaires yield a profile of functional health and well-being, based on 8 scales of physical and mental health measures: Physical Functioning, Role Limitations due to Physical Health, Bodily Pain, General Health Perceptions, Vitality, Social Functioning, Role Limitations due to Emotional Problems, and Mental Health (MH), and summary scores are produced for physical well-being and mental well-being. The summaries are scored from 0-100, with higher scores reflecting better outcomes.
Time frame: Change from baseline to Week 52
Population: Due to administrative and other issues, a majority of participants were missing scores. Evaluable data were obtained from 35 DFP and 19 DFO patients for the SF-36, and from 60 DFP and 23 DFO patients for the CHQ.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deferiprone | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | SF-36 Physical Summary | 43.1 score on a scale | Standard Error 1.8 |
| Deferiprone | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | SF-36 Mental Summary | 44.7 score on a scale | Standard Error 2.7 |
| Deferiprone | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | CHQ-PF50 Physical Summary | 29.3 score on a scale | Standard Error 1.8 |
| Deferiprone | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | CHQ-PF50 Psychosocial Summary | 42.5 score on a scale | Standard Error 1.5 |
| Deferoxamine | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | CHQ-PF50 Psychosocial Summary | 41.3 score on a scale | Standard Error 2.1 |
| Deferoxamine | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | SF-36 Physical Summary | 43.0 score on a scale | Standard Error 2 |
| Deferoxamine | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | CHQ-PF50 Physical Summary | 30.5 score on a scale | Standard Error 2.4 |
| Deferoxamine | Change in Patient-reported Quality of Life, as Measured by the Short Form Health Survey (SF-36) or the Child Health Questionnaire (CHQ-PF50). | SF-36 Mental Summary | 40.9 score on a scale | Standard Error 2.9 |