Iron chelation therapy of transfusion-dependent β-thalassemia during pregnancy in the era of novel drugs: is deferasirox toxic?

Diamantidis, Michael D.; Neokleous, Nikolaos; Agapidou, Aleka; Vetsiou, Evaggelia; Manafas, Achilles; Fotiou, Paraskevi; Vlachaki, Efthymia

doi:10.1007/s12185-016-1945-y

Cited by 23 publications

(16 citation statements)

References 23 publications

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“…Successful pregnancies following unintentional treatment with deferiprone or deferasirox have been reported 8,39,40,41. Nonetheless, the use of oral iron chelators is contraindicated in pregnant women, because of the lack of controlled data.…”

Section: Pregnancy Management In Thalassemia Majormentioning

confidence: 99%

Pregnancy in Thalassemia

Origa¹,

Comitini²

2019

Mediterr J Hematol Infect Dis

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Therapeutic advances, including the availability of oral iron chelators and new non-invasive methods for early detection and treatment of iron overload, have significantly improved the life expectancy and quality of life of patients with thalassemia, with a consequent increase in their reproductive potential and desire to have children. Hundreds of pregnancies have been reported so far, highlighting that women carefully managed during preconception usually carry out a successful gestation and labour, both in case of spontaneous conception and use of assisted reproductive techniques. A multidisciplinary team including a cardiologist, an endocrinologist and a gynaecologist, with the supervision of an expert in beta-thalassemia should be involved. During pregnancy, a close follow-up of maternal disorders and of the baby's status is recommended. Haemoglobin should be maintained over 10 g/dL to to allow normal foetal growth. Chelators are not recommended during pregnancy; nevertheless, it may reasonable to consider restarting chelation therapy with desferrioxamine towards the end of the second trimester when the potential benefit outweighs the potential foetal risk. Women with non-transfusion-dependent thalassemia who have never previously been transfused or who have received only minimal transfusion therapy are at risk of severe alloimmune anaemia if blood transfusions are required during pregnancy. Since pregnancy increases the risk of thrombosis three-fold to four-fold and thalassemia is also a hypercoagulable state, the recommendation is to keep women who are at higher risk -such as those who are not regularly transfused and those splenectomised- on prophylaxis during pregnancy and during the postpartum period. Keywords:Pregnancy, Thalassemia major, Thalassemia intermedia, Haemoglobin H disease, Counselling

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Section: Pregnancy Management In Thalassemia Majormentioning

confidence: 99%

Pregnancy in Thalassemia

Origa¹,

Comitini²

2019

Mediterr J Hematol Infect Dis

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“…DFX has also been assigned to pregnancy category C by the FDA, as animal studies have revealed evidence of embryo fetotoxicity. These studies showed decreased offspring viability and increased renal anomalies (Anastasi et al, 2011;Vini et al, 2011;Diamantidis et al, 2016).…”

Section: Pregnancy and Chelationmentioning

confidence: 99%

The new era of chelation treatments: effectiveness and safety of 10 different regimens for controlling iron overloading in thalassaemia major

Maggio

2017

Br J Haematol

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This review outlines the effectiveness and safety of 10 different regimens for controlling iron overloading in thalassaemia major (TM). For each treatment, the strength of the evidence was documented according to the guidelines of the American College of Cardiology and the American Heart Association. Serum ferritin (SF), liver iron concentration (LIC), heart T2* signal, heart damage and survival were used to assess effectiveness. Five chelation regimens out of 10 showed Level A Evidence in controlling iron overloading, as determined by SF levels and LIC. Three out of 10 chelation regimens were able to control heart iron levels, as determined by T2* signals with Level A Evidence. Two chelation regimens were able to improve/reverse heart damage and four increased of survival with Level B Evidence. These advances mean that the current survival of TM patients is now similar to that of thalassaemia intermedia patients.

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“…20 According to experts, DFO should be avoided during the first trimester, but subcutaneous administration may be considered in the second and third trimesters for patients with a strong indication for treatment. 114 As to oral chelators, according to experimental models placental transfer of DFX is minimal in rats, 115 but fetal outcome data in humans are limited to spontaneous pregnancy case reports, 116 , 117 and based on the product label DFX use is contraindicated in pregnant women.…”

Section: Antepartum Managementmentioning

confidence: 99%

Pregnancy in women with thalassemia: challenges and solutions

Petrakos

Andriopoulos

Tsironi

2016

IJWH

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Advances in treatment of thalassemia have led to the aging of thalassemic patients, and consequently concern about successful reproductive outcome is augmented. Although women with thalassemia intermedia only were considered competent of achieving pregnancy, case series reveal the willingness of both thalassemia major and thalassemia intermedia women to have a family. Pregnancy in general is characterized by dynamic multiple-system changes and increased susceptibility to oxidative stress, while homozygous, transfusion-dependent, β-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload and thalassemia intermedia, usually nontransfused, is associated with augmented risk of thromboembolic events. Pregnancy in thalassemia should be considered a high risk for both mother and fetus, and favorable outcomes are the result of continuous preconception, antenatal, and postpartum assessment and management by a team of thalassemia experts.

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Iron chelation therapy of transfusion-dependent β-thalassemia during pregnancy in the era of novel drugs: is deferasirox toxic?

Cited by 23 publications

References 23 publications

Pregnancy in Thalassemia

Pregnancy in Thalassemia

The new era of chelation treatments: effectiveness and safety of 10 different regimens for controlling iron overloading in thalassaemia major

Pregnancy in women with thalassemia: challenges and solutions

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