Comparison of Iron Chelators in the Management of Transfusion-Dependent Beta Thalassaemia Major Based on Serum Ferritin

Introduction: Iron overload remains a critical challenge in transfusion-dependent beta thalassemia major patients, necessitating effective chelation strategies. This study evaluated the comparative efficacy of combination therapy (deferoxamine plus deferasirox) versus deferasirox monotherapy in patients with severe iron overload. Methods: In this prospective, randomized controlled study, 50 transfusion-dependent beta thalassemia major patients with serum ferritin levels between 3,000-5,000 ng/mL were randomized into two groups. Group A (n=25) received combination therapy with subcutaneous deferoxamine (40-50 mg/kg/day, 5 days/week) plus oral deferasirox (20-30 mg/kg/day), while Group B (n=25) received deferasirox monotherapy (30-40 mg/kg/day). Patients were monitored over 12 months with regular assessment of serum ferritin levels, organ iron content, and safety parameters. Results: At 12 months, the combination therapy group demonstrated significantly greater reduction in serum ferritin levels compared to the monotherapy group (44.9% vs 24.9%, p<0.001). A higher proportion of patients in the combination therapy group achieved target ferritin levels <2,500 ng/mL (72% vs 32%, p<0.001). Cardiac T2* MRI showed superior improvement in the combination therapy group (mean improvement: 3.8 ± 1.2 ms vs 2.1 ± 0.9 ms, p=0.004). While both regimens demonstrated comparable safety profiles, compliance was better in the monotherapy group (92.3% vs 85.4%, p=0.02). Conclusion: Combination therapy with deferoxamine and deferasirox provides superior iron chelation compared to deferasirox monotherapy in heavily iron-overloaded thalassemia patients. Despite slightly lower compliance, the enhanced efficacy in reducing iron burden and improving cardiac iron clearance supports its use as an initial strategy in patients with severe iron overload, provided appropriate monitoring and support systems are in place.