Deferasirox failure

Liver The data sheet for Exjade (deferasirox, Novartis) has been revised and a boxed warning has been added that hepatic failure can occur and that deaths have occurred [17, 18 ]. 

Acute interstitial nephritis and renal failure have been attributed to deferasirox [24 ]. 

Deferoxamine is the oldest of the chelation therapies, and is administered typically at 40mg/kg body weight, for 8-12 h, 4 days per week. However, some patients do not receive sufficient benefit from deferoxamine and develop cardiac iron overload and failure [S ]. More recently, orally bioavailable chelators, such as deferiprone and deferasirox, have become popular. However, the oral iron chelators have shown side effects that differ from those of deferoxamine. Deferiprone has proven to be more efficacious than deferasirox in several clinical trials, and is now routinely administered when deferoxamine treatment has failed. However, it is associated with agranulocytosis in about 1% of patients through an as yet undetermined mechanism and neutropenia more rarely. Deferiprone has been in use in Europe since 1999 but was not approved in the United States until 2011, due in part to a controversy over its safety [4 ]. 

A meta-analysis describes the efficacy and safety of deferasirox for the treatment of transfusional hemosiderosis, beta-thalassaemia, sickle cell disease and bone marrow failure syndromes, including myelodysplastic syndrome and aplastic anaemia [12 ]. Reported side effects of the meta-analysis included gastrointestinal (GI) events, skin rash, transient increase in serum creatinine, abdominal pain, nausea, and diarrhoea. A second meta-analysis analysed four studies [13 ]. The authors reported that data on safety at the doses required for effective chelation are limited, however. 

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