Cochrane · systematic review · CD007476
Deferasirox for managing iron overload in people with thalassaemia
Bollig, C, Schell, LK, Rücker, G, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
49
current version
GRADE rated
25
No studies
10
Included studies
NR
No studies 10 · 20.4%Ungraded 14 · 28.6%Very low 10 · 20.4%Low 8 · 16.3%Moderate 7 · 14.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyDeferasirox compared to deferoxamine in people with transfusion‐dependent thalassemia
Population: people with transfusion‐dependent thalassemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Deferasirox vs deferoxamine | RR 0.48 [0.09, 2.63] | 8 studies · 1170 participants | Low Downgraded: risk of bias, imprecision |
Responder analysis II (responder: LIC 1 to less than 7 mg Fe/g dw) Deferasirox vs deferoxamine | RR 0.8 [0.69, 0.92] | 1 study · 553 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Serum ferritin (ng/mL): mean change from baseline and at end of study Deferasirox vs deferoxamine | no estimate extracted | 6 studies · 1002 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
LIC (mg Fe/g dw) evaluated by biopsy or SQUID: mean change from baseline Deferasirox vs deferoxamine | no estimate extracted | 1 study · 541 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Satisfaction with treatment (very satisfied or satisfied): participants previously treated with DFO Deferasirox vs deferoxamine | RR 2.2 [1.89, 2.57] | 1 study · 571 participants | Moderate Downgraded: risk of bias |
Adherence: discontinuations Deferasirox vs deferoxamine | RR 0.95 [0.6, 1.5] | 8 studies · 1211 participants | Low Downgraded: risk of bias, imprecision |
AE: investigations ‐ isolated serum creatinine increase above ULN Deferasirox vs deferoxamine | RR 2.57 [1.88, 3.51] | 2 studies · 657 participants | Low Downgraded: risk of bias, indirectness |
Deferasirox compared to deferiprone in people with transfusion‐dependent thalassemia
Population: people with transfusion‐dependent thalassemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Deferasirox vs deferiprone | no estimate extracted | 3 studies · 146 participants | Very low Downgraded: risk of bias, imprecision |
Responder analysis Deferasirox vs deferiprone | no estimate extracted | NR | No studies |
Serum ferritin (ng/mL): mean change from baseline and at end of study Deferasirox vs deferiprone | no estimate extracted | 2 studies · 83 participants | Very low Downgraded: risk of bias, imprecision |
LIC (mg/g) evaluated by MRI R2*: mean change from baseline Deferasirox vs deferiprone | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision |
Satisfaction Deferasirox vs deferiprone | no estimate extracted | NR | No studies |
Adherence: discontinuations Deferasirox vs deferiprone | RR 0.16 [0.01, 2.99] | 3 studies · 179 participants | Low Downgraded: risk of bias, imprecision |
Renal failure Deferasirox vs deferiprone | no estimate extracted | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision |
Deferasirox alone compared to combined deferasirox and deferiprone in people with transfusion‐dependent thalassemia
Population: people with transfusion‐dependent thalassaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
Responder analysis Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
Serum ferritin (ng/mL) Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
LIC (mg Fe/g dry weight) Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
Satisfaction with treatment Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
Adherence Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
AE: serum creatinine increase Deferasirox alone vs combined deferasirox and deferiprone | no estimate extracted | 1 participants | Ungraded |
Combined deferasirox and deferiprone compared to deferiprone alone in people with transfusion‐dependent thalassemia
Population: people with transfusion‐dependent thalassemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
Responder analysis Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
Serum ferritin (ng/mL) Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
LIC (mg Fe/g dry weight) Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
Satisfaction with treatment Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
Adherence Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
AE: Serum creatinine increase Combined deferasirox and deferiprone vs deferiprone alone | no estimate extracted | 1 participants | Ungraded |
Deferasirox and deferoxamine compared to deferoxamine in people with transfusion‐dependent thalassemia
Population: people with transfusion‐dependent thalassemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | 1 study · 94 participants | Low Downgraded: imprecision |
Responder analysis Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | NR | No studies |
Serum ferritin (ng/mL) ‐ mean at end of study Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | 1 study · 94 participants | Very low Downgraded: risk of bias, imprecision |
LIC Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | NR | No studies |
Satisfaction with treatment Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | NR | No studies |
Adherence: Discontinuations Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | 1 study · 94 participants | Very low Downgraded: risk of bias, imprecision |
AE: serum creatinine increased Deferasirox and deferoxamine vs deferoxamine | no estimate extracted | NR | No studies |
Deferasirox and deferiprone compared to deferiprone and deferoxamine in people with transfusion‐dependent thalassemia
Population: people with transfusion‐dependent thalassemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Deferasirox and deferiprone vs deferiprone and deferoxamine | no estimate extracted | 1 study · 96 participants | Low Downgraded: imprecision |
Responder analysis Deferasirox and deferiprone vs deferiprone and deferoxamine | no estimate extracted | NR | No studies |
Serum ferritin (ng/mL): mean change from baseline Deferasirox and deferiprone vs deferiprone and deferoxamine | no estimate extracted | 1 study · 96 participants | Very low Downgraded: risk of bias, imprecision |
LIC evaluated by MRI R2*: mean change from baseline Deferasirox and deferiprone vs deferiprone and deferoxamine | no estimate extracted | 1 study · 96 participants | Low Downgraded: risk of bias, imprecision |
Satisfaction Deferasirox and deferiprone vs deferiprone and deferoxamine | no estimate extracted | NR | No studies |
Adherence: Discontinuations Deferasirox and deferiprone vs deferiprone and deferoxamine | no estimate extracted | 1 study · 96 participants | Very low Downgraded: risk of bias, imprecision |
Drug‐related AE: serum creatinine increased (≥ 33%) above baseline in 2 consecutive occasions Deferasirox and deferiprone vs deferiprone and deferoxamine | RR 3 [0.32, 27.83] | 1 study · 96 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Deferasirox compared to placebo in people with non‐transfusion‐dependent thalassemia
Population: people with non‐transfusion‐dependent thalassemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any time point Deferasirox vs placebo | no estimate extracted | 1 study · 148 participants | Moderate Downgraded: imprecision |
Responder analysis Deferasirox vs placebo | no estimate extracted | NR | No studies |
Serum ferritin (ng/mL): mean change from baseline Deferasirox vs placebo | no estimate extracted | 1 study · 154 participants | Moderate Downgraded: imprecision |
LIC (mg Fe/g dry weight) evaluated by MRI R2: least squares mean change from baseline Deferasirox vs placebo | no estimate extracted | 1 study · 159 participants | Moderate Downgraded: imprecision |
Satisfaction with treatment Deferasirox vs placebo | no estimate extracted | NR | No studies |
Adherence: Discontinuations Deferasirox vs placebo | RR 1.32 [0.5, 3.52] | 1 study · 166 participants | Low Downgraded: imprecision |
AE: abnormal serum creatinine (post‐baseline) Deferasirox vs placebo | RR 3.59 [0.19, 68.4] | 1 study · 166 participants | Very low Downgraded: imprecision, indirectness |
Deferasirox compared to Deferoxamine for People with thalassaemia and secondary iron overload
Population: People with thalassaemia and secondary iron overload
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at any point in time Deferasirox vs Deferoxamine | RR 0.33 [0.03, 3.12] | 2 studies · 622 participants | Low Downgraded: risk of bias, imprecision |
Responder analysis (Responder: LIC: 1 to less than 7 mg Fe/g dw) Deferasirox vs Deferoxamine | RR 0.8 [0.69, 0.92] | 1 study · 553 participants | Low Downgraded: risk of bias, inconsistency, indirectness |
Mean change in serum ferritin (µg/l) Deferasirox vs Deferoxamine | no estimate extracted | 1 study · 563 participants | Moderate Downgraded: risk of bias, inconsistency |
Change in LIC (mg Fe/g dw) evaluated by biopsy or SQUID Deferasirox vs Deferoxamine | no estimate extracted | 1 study · 541 participants | Moderate Downgraded: risk of bias, indirectness |
Satisfaction with treatment (very satisfied or satisfied): Patients previously treated with DFO questionnaire Deferasirox vs Deferoxamine | RR 1.82 [1.61, 2.05] | 1 study · 571 participants | Moderate Downgraded: risk of bias |
Discontinuations Deferasirox vs Deferoxamine | RR 1.19 [0.62, 2.29] | 1 study · 657 participants | Low Downgraded: risk of bias, imprecision |
Adverse event: Isolated serum creatinine increase above upper limit of normal Deferasirox vs Deferoxamine | RR 2.57 [1.88, 3.51] | 2 studies · 657 participants | Low Downgraded: risk of bias, indirectness |