Options for Iron Chelation Therapy

Iron chelation therapy is very effective at putting a patient in a negative iron balance, even with continued transfusions, as long as the patient can tolerate therapy, says Morey Blinder, MD.

Several chelating agents are available. Deferoxamine, which is given intravenously or subcutaneously, is the oldest chelating agent and deferasirox, or Exjade, or a more modern therapy. Although effective, Exjade was associated with nausea, vomiting, and diarrhea, in some patients. The latest advance is a new formulation of deferasirox, called Jadenu, which has recently become available.

The greatest concern with deferasirox, in the form of Exjade, says Blinder, is adherence to therapy. Jadenu is much better tolerated in terms of gastrointestinal toxicities, and also is much easier for the patient to take. Blinder says that he is switching his patients from Exjade to the newer formulation. The response from patients has been a positive one, which Blinder finds very gratifying.