New developments in the area of
iron and other
metal metabolism and toxicity and the effects and uses of
chelators have been presented at the 16th International Conference on Chelation (ICOC), Limassol, Cyprus in October 2006. Marketing practices by
pharmaceutical companies, contradictory policies by regulatory authorities and ineffective policies by health authorities deprive thousands of
thalassemia and other transfused patients of life saving
iron chelating drugs and of efficacious chelation treatments. Thousands of patients were using
deferasirox (
DFRA) worldwide a few months after the European Union (EU) authorities, and about 1 year after the Food and Drugs Administration (FDA), proceeded to its accelerated approval with no sufficient evidence that the
drug was efficacious, especially for clearing excess cardiac
iron, and also safe. Cases of fatal, acute, irreversible renal and
liver failure, fatal
agranulocytosis and other toxicities have recently been reported with
DFRA. The FDA has not yet approved
deferiprone (L1) depriving thousands of patients of potentially life saving treatment. The high cost of
DFRA at 60 euros/g, L1 at 5.5 euros/g and
deferoxamine (DFO) at 8.3 euros/g, diminishes the prospects of universal
chelation therapy, especially for patients in developing countries. The safety and efficacy record of L1, DFO, and their combination in particular, appear to provide universal solutions in the treatment of transfusional
iron overload, and also in reducing mortality because of their ability to clear rapidly and effectively excess cardiac
iron.