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YILDIRIM F, KOCA YOZGAT A, TATLI DOĞAN H, TURHAN N, YARALI HN, ÖZBEK NY. Is serum ferritin level or T2-sequence magnetic resonance imaging more effective in predicting liver iron in transfusion-dependent thalassemia cases? EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1167238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Iron overload in transfusion-dependent thalassemia patients is a condition that requires continuous chelation therapy and monitoring. Determination of serum ferritin level is considered a simple method to monitor body iron load; however, it highlights that other methods of liver iron level determination, such as magnetic resonance imaging (MRI), are more precise.
Materials and Methods: In order to contribute to understanding of liver iron load in thalassemia, liver iron level results of 14 transfusion-dependent thalassemia patients who underwent liver biopsy in preparation for stem cell transfusion were compared with liver T2 MRI and serum ferritin results.
Results: The mean serum Ferritin value was 2488.43±1520.18 mg/L. When liver iron load was evaluated according to T2*MRI results, mild iron accumulation was found in eight patients, moderate level in five patients, and advanced iron accumulation in a patient. According to the modified Scheuer classification, iron level in biopsies was grade 1 in two patients; grade 2 in seven patients; It was grade 3 in three patients and grade 4 in two patients. As the ferritin level increased, the liver iron biopsy score also increased statistically significantly (r=0.544 and p=0.044). There was a statistically significant and inverse correlation between liver T2*MRI level and liver iron biopsy score (r=-0.724 and p=0.003). Ferritin level was not found statistically significant in differentiating iron level according to liver biopsy iron score (p=0.096). The area under the ROC curve for T2*MRI measurements was statistically significant (AUC=0.967; 95% CI: 0.880-1,000 and p=0.005).
Conclusıon: In our study, we found that serum ferritin and T2 MRI results were correlated with liver biopsy iron levels. However, we found that the sensitivity and specificity of ferritin level in liver biopsy to show iron level was low, and the sensitivity and specificity of T2 MRI was high.
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Affiliation(s)
- Fatma YILDIRIM
- Ankara Şehir Hastanesi, Patoloji Bölümü, Ankara, Türkiye
| | - Ayça KOCA YOZGAT
- Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Ankara Şehir Hastanesi, Çocuk Hastalıkları Anabilim Dalı, Çocuk Hematoloji ve Onkolojisi Bilim Dalı, Ankara,Türkiye
| | - Hayriye TATLI DOĞAN
- Ankara Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Ankara Şehir Hastanesi, Patoloji Anabilim Dalı, Ankara, Türkiye
| | - Nesrin TURHAN
- Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Ankara Şehir Hastanesi, Patoloji Anabilim Dalı, Ankara, Türkiye
| | - Hüsniye Neşe YARALI
- Ankara Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Ankara Şehir Hastanesi, Çocuk Hastalıkları Anabilim Dalı, Çocuk Hematoloji ve Onkolojisi Bilim Dalı, Ankara, Türkiye
| | - Namık Yaşar ÖZBEK
- Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Ankara Şehir Hastanesi, Çocuk Hastalıkları Anabilim Dalı, Çocuk Hematoloji ve Onkolojisi Bilim Dalı, Ankara,Türkiye
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Safety and efficacy of direct-acting antiviral drugs in the treatment of chronic hepatitis C virus infection in patients with thalassemia: a prospective study. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
Background
Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality among thalassemic patients. Direct-acting antiviral agents (DAAs) are highly effective and well-tolerated by chronic HCV patients.
Results
The mean age of our patients was 29 years. Sustained virologic response (SVR) at 12 and 24 weeks was achieved in all patients (100%). The most common side effects were fatigue (18%), anemia (13.63%), and headache (4.5%). There was no statistically significant difference in the hemoglobin level before and after treatment (p = 0.48). There was a significant improvement in serum bilirubin and mean ALT levels after treatment compared to baseline data (p < 0.0005 each).
Conclusions
DAAs, namely, sofosbuvir plus daclatasvir or sofosbuvir plus ledipasvir, are effective and well-tolerated regimens in thalassemic patients with chronic HCV.
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Sinakos E, Kountouras D, Koskinas J, Zachou K, Karatapanis S, Triantos C, Vassiliadis T, Goulis I, Kourakli A, Vlachaki E, Toli B, Tampaki M, Arvaniti P, Tsiaoussis G, Bellou A, Kattamis A, Maragkos K, Petropoulou F, Dalekos GN, Akriviadis E, Papatheodoridis GV. Treatment of chronic hepatitis C with direct-acting antivirals in patients with β-thalassaemia major and advanced liver disease. Br J Haematol 2017; 178:130-136. [PMID: 28439915 DOI: 10.1111/bjh.14640] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/31/2016] [Indexed: 02/06/2023]
Abstract
Interferon-based regimens for chronic hepatitis C (CHC) were often deferred in patients with β-thalasaemia major (β-TM) due to poor efficacy and tolerance. Current guidelines recommend direct-acting antivirals (DAAs) for these patients. The aim of this study was to assess the safety and efficacy of DAAs in patients with β-TM and advanced liver disease due to CHC. Patients were recruited from eight liver units in Greece. The stage of liver disease was assessed using transient elastography and/or liver histology. Five regimens were used: sofosbuvir (SOF) + ribavirin (RBV); SOF + simeprevir ± RBV; SOF + daclatasvir ± RBV; ledipasvir/SOF ± RBV and ombitasvir/paritaprevir-ritonavir + dasabuvir ± RBV. Sixty-one patients (median age 43 years) were included. The majority of patients was previously treated for hepatitis C (75%) and had cirrhosis (79%). Viral genotype distribution was: G1a: n = 10 (16%); G1b: n = 22 (36%); G2: n = 2 (3%); G3: n = 14 (23%); G4: n = 13 (22%). The predominant chelation therapy was a combination of deferoxamine and deferiprone (35%). Overall sustained virological response rates were 90%. All treatment regimens were well tolerated and no major adverse events or drug-drug interactions were observed. Approximately half of the patients who received RBV (7/16, 44%) had increased needs for blood transfusion. Treatment of CHC with DAAs in patients with β-TM and advanced liver disease was highly effective and safe.
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Affiliation(s)
- Emmanouil Sinakos
- 4th Medical Department, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Dimitrios Kountouras
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.,Mitera Hospital, Athens, Greece
| | - John Koskinas
- 2nd Medical Department, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | | | - Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Themistoklis Vassiliadis
- 3rd Medical Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Goulis
- 4th Medical Department, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | | | - Efthymia Vlachaki
- Thalassaemia Unit, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tampaki
- 2nd Medical Department, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Pinelopi Arvaniti
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Georgios Tsiaoussis
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Aristea Bellou
- 3rd Medical Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Kattamis
- Agia Sofia Children Hospital, University of Athens, Athens, Greece
| | | | | | - George N Dalekos
- 2nd Medical Department, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Evangelos Akriviadis
- 4th Medical Department, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - George V Papatheodoridis
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Aminizadeh E, Alavian SM, Akbari Sari A, Ebrahimi Daryani N, Behnava B. Safety and Efficacy of Adding Ribavirin to Interferon or Peginterferon in Treatment of Hepatitis C Infection in Patients With Thalassemia: A Systematic Review on Randomized Controlled Trials. HEPATITIS MONTHLY 2016; 16:e28537. [PMID: 27226796 PMCID: PMC4876663 DOI: 10.5812/hepatmon.28537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 01/19/2023]
Abstract
CONTEXT Hepatitis C virus (HCV) infection is a major cause of liver-morbidity and mortality among patients with thalassemia. Peginterferon plus ribavirin is currently the recommended therapy for hepatitis C infection in patients do not have thalassemia, but using ribavirin in patients with thalassemia is restricted due to its hemolytic effect. To evaluate the efficacy and safety of adding ribavirin to peginterferon or interferon, authors performed a systematic review on the available literatures. EVIDENCE ACQUISITION Trials were identified through electronic database, manual searches of journals and bibliographies and approaching authors of trials. Randomized trials that enrolled patients with a diagnosis of thalassemia and chronic hepatitis C infection treated with interferon or peginterferon with or without ribavirin were included. Two investigators independently evaluated the trials for inclusion criteria, risk of bias and data extraction. The primary outcomes were sustained virological response (SVR), liver-related morbidity, mortality and adverse events. The odds ratios from each trial were calculated individually and in the subgroup analysis of trials. Data were analyzed with fixed-effect model. RESULTS Three randomized clinical trials with 92 patients were included. All three trials had unclear risk of bias. Compared with peginterferon monotherapy, adding ribavirin to peginterferon had significant beneficial effect on sustained virological response (OR = 3.44, 95% CI: 1.18 - 10.06). There was no significant difference between combination therapy and monotherapy in the end of treatment achievement response. Other than about 30% increase in blood transfusion due to anemia that returned to normal level 2 - 3 months after treatment, there was no significant increase in side effects followed by adding ribavirin to pegylated interferon (Peg-IFN). Data were insufficient to determine the impact of genotype, viral load and age on the response to treatment. CONCLUSIONS Compared with monotherapy, adding ribavirin to treatment is more effective in removing hepatitis C virus from the bloodstream in patients with thalassemia, it is also more effective in reducing the relapse rate after treatment. Except the increase in blood transfusion, there was no significant increase in side effects followed by adding ribavirin.
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Affiliation(s)
- Ehsan Aminizadeh
- Department of Gastroenterology, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Ehsan Aminizadeh, Department of Gastroenterology, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166831748, Fax: +98-2188958935, E-mail:
| | - Seyed Moayyed Alavian
- Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Bita Behnava
- Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Dessì C, Leoni G, Moi P, Danjou F, Follesa I, Foschini ML, Morittu M, Zappu A, Defraia E, Bina P, Cunico A, Civolani A, Podda RA, Origa R. Thalassemia major between liver and heart: Where we are now. Blood Cells Mol Dis 2015; 55:82-8. [DOI: 10.1016/j.bcmd.2015.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/29/2015] [Indexed: 02/08/2023]
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