Decreasing cardiac iron overload with Amlodipine and Spirulina in children with β-thalassemia

El-Haggar, Sahar Mohamed; El-Shanshory, Mohamed; Elshafey, Rasha; Dabour, Mohamed S.

doi:10.1016/j.phoj.2018.10.001

Cited by 6 publications

(14 citation statements)

References 55 publications

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“…The serum ferritin level decreased after combination therapy with amlodipine in a rate of 150 ng/mL, compared to 393 ng/mL in spirulina group. A greater rise in myocardial MRI T2* was detected in patients under amlodipine treatment versus spirulina (2.7 versus 1.14, Cohen's d 0.20, −0.42 to 0.82, NNT 9) 20 …”

Section: Discussionmentioning

confidence: 95%

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A double‐blind, controlled, crossover trial of amlodipine on iron overload status in transfusion dependent β‐thalassemia patients

et al. 2021

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Background and aim: This study examined whether administration of amlodipine could improve myocardial iron loading status in patients with transfusion dependent β-thalassemia (TDT), through a placebo-controlled, crossover study. Methods: Amlodipine (5 mg, daily) or placebo were prescribed to all patients (n = 19) for 6 months, and after a 2-week washout period, patients were crossed over to the other group. The efficacy of amlodipine on iron loading was assessed by measuring myocardial T2*-weighted magnetic resonance imaging (MRI T2*, millisecond [ms]) and serum ferritin (ng/mL).Results: Seventeen patients completed the study. The mean ± standard deviation[SD] of myocardial MRI T2* at baseline was 9.83 ± 2.67 ms Myocardial MRI T2* value rose to 11.44 ± 4.14 ms post amlodipine treatment in all patients. After placebo, myocardial MRI T2* value reached 10.29 ± 4.01 ms After controlling the baseline measures, Hedges's g for ferritin and myocardial MRI T2* outcomes were estimated 3.84 (95% confidence interval [CI] 2.68 to 4.97) and −1.80 (95% CI −2.58 to −0.10), respectively. Conclusion:Amlodipine might improve myocardial MRI T2* and serum ferritin level compared to placebo. However, larger clinical studies are needed to confirm the results.

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Section: Discussionmentioning

confidence: 95%

“…A clinical trial carried out on 40 children with β‐thalassemia showed that treatment with both amlodipine and spirulina could remarkably increase myocardial MRI T2* after 3 months 20 . The serum ferritin level decreased after combination therapy with amlodipine in a rate of 150 ng/mL, compared to 393 ng/mL in spirulina group.…”

Section: Discussionmentioning

confidence: 99%

A double‐blind, controlled, crossover trial of amlodipine on iron overload status in transfusion dependent β‐thalassemia patients

et al. 2021

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“…The follow‐up period ranged from 6–12 months. The shortest follow‐up period was in Haggar et al 20 , which was 3 months 20 . In all studies, amlodipine was compared against placebo, except for Haggar et al, 20 in which the comparator was spirulina.…”

Section: Resultsmentioning

confidence: 99%

“…It is important to mention that these studies have multiple limitations. First, all of these studies included Haggar et al, which compared amlodipine against spirula 20 . We believe that the introduction of this study has led to inaccurate results since the other studies compared amlodipine against placebo rather than spirula.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of calcium channel blockers in preventing cardiac siderosis in thalassemia patients: An updated meta‐analysis with trial sequential analysis

Soliman

Abdelaziz

Mouffokes

et al. 2023

European J of Haematology

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Objectives Iron overload in patients with thalassemia represents a serious complication by affecting numerous organ systems. This meta‐analysis aims to establish an evidence regarding the effect of amlodipine on cardiac iron overload in thalassemia patients. Methods We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for all relevant randomized controlled trials (RCTs). The primary outcomes were cardiac T2* and myocardial iron concentration (MIC). Secondary outcomes were liver iron concentration (LIC), risk of Gastrointestinal (G.I.) upset and risk of lower limb edema. We used Hedges' g to pool continuous outcomes, while odds ratio was used for dichotomous outcomes. Results Seven RCTs were eligible for this systematic review and meta‐analysis, comprising of 233 patients included in the analysis. Amlodipine had a statistically significant lower MIC (Hedges' g = −0.82, 95% confidence interval [CI] [−1.40, −0.24], p < .001) and higher cardiac T2* (Hedges' g = 0.36, 95% CI [0.10, 0.62], p = .03). Amlodipine was comparable to standard chelation therapy in terms of the risk of lower limb edema and GI upset. Conclusion Our meta‐analysis found that amlodipine significantly increases cardiac T2* and decreases MIC, hence decreasing the incidence of cardiomyopathy‐related iron overload in thalassemia patients.

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Calcium channel blockers for preventing cardiomyopathy due to iron overload in people with transfusion-dependent beta thalassaemia

Padhani,

Gangwani,

Sadaf

et al. 2023

Cochrane Database of Systematic Reviews

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Decreasing cardiac iron overload with Amlodipine and Spirulina in children with β-thalassemia

Cited by 6 publications

References 55 publications

A double‐blind, controlled, crossover trial of amlodipine on iron overload status in transfusion dependent β‐thalassemia patients

A double‐blind, controlled, crossover trial of amlodipine on iron overload status in transfusion dependent β‐thalassemia patients

Efficacy and safety of calcium channel blockers in preventing cardiac siderosis in thalassemia patients: An updated meta‐analysis with trial sequential analysis

Calcium channel blockers for preventing cardiomyopathy due to iron overload in people with transfusion-dependent beta thalassaemia

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