Comparative Effects of Three Iron Chelation Therapies on the Quality of Life of Greek Patients with Homozygous Transfusion-Dependent Beta-Thalassemia

Abstract

This prospective study assessed the quality of life of patients with homozygous transfusion-dependent beta-thalassemia in Greece receiving three different iron chelation treatments. Patients enrolled were receiving one of the following chelation therapies: deferoxamine (n = 21), deferasirox (n = 75), or deferoxamine in combination with deferiprone (n = 39). The three groups were compared in terms of their quality of life, satisfaction and adherence to treatment, control of their health, and self-esteem through the completion of five questionnaires. A higher percentage of patients receiving deferoxamine felt that their treatment negatively influenced their body and skin appearance and limited their ability to work, attend school, and perform daily tasks (P = 0.0066). The adherence to treatment rate and self-esteem were the lowest in the deferoxamine group (P < 0.05). The deferoxamine group also had the lowest physical component summary score in the SF-36 questionnaire (P = 0.014). This study suggests that the quality of life of beta-thalassemia patients receiving chelation therapy is dependent on the type of iron chelation treatment they receive. The study provides insight into important factors associated with the quality of life of these patients, which are essential for developing a more suitable clinical support team and counseling in order to maximize the treatment benefits for these patients in daily clinical practice.

Evaluating Health-Related Quality of Life (HRQoL) in Iraqi Adult and Pediatric Patients with Beta-Thalassemia Major Using Two Different Iron Chelation Therapies

“…Despite the difference between the present study and other previous studies in questionnaires, methodologies, and number of patients used, our scores of QoL domains in both DFO and DFX groups were comparable to many other studies (19,27,28) and showed severe impairment in all aspects of QoL, table (4). Adult patients using DFX show better QoL than patients' using DFO, and this was consistent with many studies (19,29,30) . Table (5) shows a significant direct relationship between DFX and all QoL domains; this was explained by Goulas et al (30) who reported that patients are more adherent to the oral iron chelator which is considered an important parameter for treatment success.…”

The Effect of Biopsychosocial Variables in Fatigue in Patients with Hemoglobinopathies

“…As we can see from the final models in the regression analysis, the use of combination chelation therapy (Desferrioxamine & Deferoxamine) had a positive effect in physical fatigue, which means that it correlates with reduced fatigue, while the use of subcutaneous chelation therapy (Desferrioxamine) had a negative effect in general fatigue and was correlated with increased fatigue. Our results supports the findings of other studies that different types of chelation therapy have a significant effect on health self-assessment, with patients receiving oral chelation therapy reporting better HRQoL (Lourenco et al, 2005) and is consistence with other studies that suggests that the quality of life of beta thalassemia major patients is dependent on type of iron chelation treatment which they received (Seyedifar et al, 2016;Karnon et al, 2008;Goulas, Kourakli-Symeonidis, & Camoutsis, 2012). Also, according to previous studies, patients receiving Desferrioxamine were more likely to suffer from fatigue, as well as depression, dyspnea, and decreased physical functioning (Abetz et al, 2006;Pakbaz et al, 2005) Another important factor explaining fatigue, seems to be the qualitative characteristics of fatigue, which was revealed from the opposite correlation, between the variables "existence of fatigue for a period between two weeks and a month" with "existing fatigue before transfusion for less than seven days".…”

Optimising management of deferasirox therapy for patients with transfusion‐dependent thalassaemia and lower‐risk myelodysplastic syndromes

“…49 Of 21 patients receiving deferoxamine and 75 patients receiving deferasirox DT in a second study, only 10% and 33% of patients, respectively, reported that they always adhered to treatment. 48 Among patients with a prior history of iron chelation therapy in the EPIC trial, the proportion of patients with transfusion-dependent thalassaemia who reported always following their iron chelation therapy regimen as recommended by their physician increased from 58 of 179 (32%) patients at baseline to 116 of 173 (67%) patients at end of study (ie, after 1 year's therapy with deferasirox DT or at the time of early discontinuation). 35 In patients with MDS, adherence was reported by 35 of 56 (63%) patients at baseline and 36 of 42 (86%) patients at end of study.…”

“…Patients with transfusiondependent thalassaemia enrolled in a prospective nonrandomised study reported that deferasirox (n = 75) had less negative impact than deferoxamine (n = 21) on HRQoL, the ability to perform daily tasks, and body and skin appearance, which are all factors that may impact adherence. 48 In a multinational study, over 40% of patients receiving deferoxamine infusions (n = 79) reported problems at least sometimes with sticking themselves or with wearing the pump, and patients with poor adherence to deferoxamine also reported issues such as the infusions being painful and the injection site being sore, saturated or leaking. 40 Convenience and administration frequency may affect adherence.…”