Which agents are used for iron chelation in patients with sickle cell disease (SCD)?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Three agents are available for iron chelation: deferoxamine, deferasirox, and deferiprone.

Deferoxamine is an efficient iron chelator. It is administered as a prolonged infusion intravenously or subcutaneously for 5-7 days a week. Although effective, there are significant challenges associated with its use that can result in non-compliance. [77]

Deferiprone and deferasirox, oral iron chelators, are effective for iron overload treatment and have differences (eg, different pharmacokinetics and adverse effect profiles). Deferasirox has a capacity similar to  deferoxamine in chelating iron, but it is administered orally. Renal toxicity might be a limiting factor in its use, but it is generally safe. Deferiprone does not seem to be as effective as the other 2 agents and is considered a second-line therapy. Unlike deferasirox and deferoxamine, it selectively removes cardiac iron; is most effective when used in combination with deferoxamine or deferasirox. 

A novel new iron chelator is being developed but is still in the clinical testing phase. [78]

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