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Long‐term trial with the oral iron chelator 1,2‐dimethyl‐3‐hydroxypyrid‐4‐one (L 1 ) I. IRON CHELATION AND METABOLIC STUDIES
Author(s) -
Kontoghiorghes G. J.,
Bartlett A. N.,
Hoffbrand A. V.,
Goddard J. G.,
Sheppard L.,
And J. Barr,
Nortey P.
Publication year - 1990
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1990.tb07887.x
Subject(s) - excretion , urine , deferasirox , chelation therapy , urinary system , iron status , medicine , serum iron , serum ferritin , chelation , ferritin , chemistry , gastroenterology , thalassemia , hemoglobin , anemia , iron deficiency , inorganic chemistry
S ummary A long‐term clinical trial of 1‐15 months has been carried out with the oral iron chelator 1.2‐dimethyl‐3‐hydroxypyrid‐4‐one (L 1 ) in 13 transfusion‐dependent ironloaded patients. Urinary iron excretion was greatest in patients with thalassaemia major and was related to the number of previous transfusions but not to the serum ferritin level. Substantial increases of urinary iron were observed in all the patients when the frequency of the daily dose was doubled and in response to 2 ± 3 g L 1 daily 11 of 12 patients tested excreted > 2 5 mg iron daily, the mean daily intake of iron from transfusion. Serum ferritin levels have fluctuated but overall have remained unchanged. Pharmacological studies in five patients have indicated rapid absorption probably from the stomach and variable plasma half life of 77 ± 35 min (SD). Glucuronation was identified as a major route of L 1 metabolism. Short‐term intensive chelation studies using repeated administration of L 1 resulted in further increases of urinary iron excretion by comparison to a single dose. In one case 325 mg of iron were excreted in the urine following the administration of 16g (5 ± 2g + 2 ± 3g) within 24 h. Iron excretion studies were carried out in six transfusional iron‐loaded patients who were maintained on a low iron diet before and during chelation. No significant increases of faecal iron excretion were observed with L 1 using daily doses of up to 3.3 g and 4 ± 2 g. The high level of compliance during treatment with L 1 and the levels of urine iron excretion that can be achieved increase the prospects for oral chelation in transfusional iron‐loaded patients.