Comparison of DFO, DFP, and DFX
| . | DFO (DFO) . | DFP (DFP) . | DFX (DFX) . |
|---|---|---|---|
| Molecular weight | 560 | 139 | 373 |
| Chelator: iron | 1:1 (hexandentate) | 3:1 (bidentate) | 2:1 (tridentate) |
| Route of administration | Subcutaneous or intravenous | Oral tablets or liquid | Oral suspension |
| Iron excretion | Urine, fecal | Urine | Fecal |
| Plasma half-life | 20 min | 1-3 h | 8-16 h |
| Usual dose | 40 mg/kg/d | 75-100 mg/kg/d | 20-40 mg/kg/d |
| Licensed | Licensed for treatment of chronic iron overload resulting from transfusion-dependent anemia | In Europe, North America, and Asia: for treatment of iron overload in TM where DFO is contraindicated or inadequate | In the United States, licensed for treatment of transfusional iron overload in patients 2 years or older. In Europe, approved for treatment of transfusional iron overload in TM, 6 years and older and when DFO is contraindicated and inadequate, in patients with other anemias, patients 2-5 years old and in nontransfusion-dependent thalassemia |
| Cardiac iron removal | Compliance problem; not effective in all compliant patients; continuous infusion more effective | Most effective of the 3 chelators; used with continuous DFO in cardiac failure | Reduces LIC and improves liver pathology; reduces cardiac iron in 3-year study |
| Annual cost (54 kg body weight) | 40 mg/kg/5 d = £4788* | 75 mg/kg/d = £4505 | 20 mg/kg/d = £13 245 |
| (United Kingdom NHS) | 100 mg/kg/d = £6007 | 30 mg/kg/d = £19 865 | |
| Not applicable at the same rate in all countries | 40 mg/kg/d = £26 490 | ||
| Main side effects | Local reactions, auditory, retina, allergy, bone abnormalities, Yersinia infection | Gastrointestinal, neutropenia/ agranulocytosis, arthralgia, liver enzyme rise, zinc deficiency† | Gastrointestinal, rash, renal, liver† |
| Advantages | 36 years of experience | Best for cardiac iron removal | Once-daily administration |
| Disadvantages | Mode of administration, lack of compliance | Weekly blood count monitoring in first year | Cost |
| . | DFO (DFO) . | DFP (DFP) . | DFX (DFX) . |
|---|---|---|---|
| Molecular weight | 560 | 139 | 373 |
| Chelator: iron | 1:1 (hexandentate) | 3:1 (bidentate) | 2:1 (tridentate) |
| Route of administration | Subcutaneous or intravenous | Oral tablets or liquid | Oral suspension |
| Iron excretion | Urine, fecal | Urine | Fecal |
| Plasma half-life | 20 min | 1-3 h | 8-16 h |
| Usual dose | 40 mg/kg/d | 75-100 mg/kg/d | 20-40 mg/kg/d |
| Licensed | Licensed for treatment of chronic iron overload resulting from transfusion-dependent anemia | In Europe, North America, and Asia: for treatment of iron overload in TM where DFO is contraindicated or inadequate | In the United States, licensed for treatment of transfusional iron overload in patients 2 years or older. In Europe, approved for treatment of transfusional iron overload in TM, 6 years and older and when DFO is contraindicated and inadequate, in patients with other anemias, patients 2-5 years old and in nontransfusion-dependent thalassemia |
| Cardiac iron removal | Compliance problem; not effective in all compliant patients; continuous infusion more effective | Most effective of the 3 chelators; used with continuous DFO in cardiac failure | Reduces LIC and improves liver pathology; reduces cardiac iron in 3-year study |
| Annual cost (54 kg body weight) | 40 mg/kg/5 d = £4788* | 75 mg/kg/d = £4505 | 20 mg/kg/d = £13 245 |
| (United Kingdom NHS) | 100 mg/kg/d = £6007 | 30 mg/kg/d = £19 865 | |
| Not applicable at the same rate in all countries | 40 mg/kg/d = £26 490 | ||
| Main side effects | Local reactions, auditory, retina, allergy, bone abnormalities, Yersinia infection | Gastrointestinal, neutropenia/ agranulocytosis, arthralgia, liver enzyme rise, zinc deficiency† | Gastrointestinal, rash, renal, liver† |
| Advantages | 36 years of experience | Best for cardiac iron removal | Once-daily administration |
| Disadvantages | Mode of administration, lack of compliance | Weekly blood count monitoring in first year | Cost |