Combination of Deferoxamine and Deferiprone demonstrates superior efficiency compared to monotherapies in management of cardiac iron overload: Evidence from meta-analysis.

OBJECTIVE: Cardiac iron overload is a significant but treatable complication linked to various diseases. Iron chelators, such as Deferasirox (DFX), Deferiprone (DFP), and Deferoxamine (DFO), are commonly prescribed either as monotherapy or in combination for the treatment of systemic iron overload. However, the management of cardiac iron overload remains challenging owing to the absence of a standardized chelation regimen exclusively for the management of the condition in patients. This meta-analysis intends to evaluate the comparative efficacy of different iron chelation regimens for the treatment of cardiac iron overload.

METHODS: The meta-analysis included twenty-nine studies (2000-2025) and applied a random-effects model to calculate Hedges' g summary effect and assess heterogeneity to assess the efficacy of the chelation regimens in increasing cardiac T2∗ values. Pooled analysis of cardiac T2∗ change between chelation regimens for patients with significant cardiac iron overload was also performed to establish the most effective chelation regimen for the treatment of this condition.

RESULTS: Among the iron chelation therapies, DFO-DFP combination produced the largest and significant improvement (Hedges' g = 1.11), followed by DFX-DFO combination (Hedges' g = 0.53). In patients with baseline cardiac T2∗ <20 ms, DFO-DFP combination achieved the greatest mean increase of cardiac T2∗ values (7.51 ms), followed by DFO monotherapy and DFX-DFO combination.

CONCLUSION: The combination of Deferoxamine and Deferiprone demonstrated comparatively greater efficacy than the other evaluated regimens in decreasing cardiac iron overload. However, this finding should be interpreted with caution in consideration of the study limitations when applied to clinical decision-making.