Efficacy and safety of calcium channel blockers in preventing cardiac siderosis in thalassemia patients: An updated meta‐analysis with trial sequential analysis. (2nd January 2023)

• Record Type: Journal Article
• Authors: Soliman, Youssef; Abdelaziz, Ahmed; Mouffokes, Adel; Amer, Basma E.; Goudy, Yomna Mohamed; Abdelwahab, Omar Ahmed; Badawy, Marwa M.; Diab, Rehab Adel; Elsharkawy, Asmaa
• Is Part Of: European journal of haematology. Volume 110:Number 4(2023)
• Page Start: 414
• Page End: 425
• Publication Date: 2023-01-02
• Subjects: amlodipine -- cardiac T2* -- iron overload -- thalassemia; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; Blood -- Periodicals; 616.15005
• DOI: 10.1111/ejh.13919
• Languages: English
• ISSNs: 0902-4441

Abstract

Abstract: Objectives: Iron overload in patients with thalassemia represents a serious complication by affecting numerous organ systems. This meta‐analysis aims to establish an evidence regarding the effect of amlodipine on cardiac iron overload in thalassemia patients. Methods: We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for all relevant randomized controlled trials (RCTs). The primary outcomes were cardiac T2* and myocardial iron concentration (MIC). Secondary outcomes were liver iron concentration (LIC), risk of Gastrointestinal (G.I.) upset and risk of lower limb edema. We used Hedges' g to pool continuous outcomes, while odds ratio was used for dichotomous outcomes. Results: Seven RCTs were eligible for this systematic review and meta‐analysis, comprising of 233 patients included in the analysis. Amlodipine had a statistically significant lower MIC (Hedges' g = −0.82, 95% confidence interval [CI] [−1.40, −0.24], p < .001) and higher cardiac T2* (Hedges' g = 0.36, 95% CI [0.10, 0.62], p = .03). Amlodipine was comparable to standard chelation therapy in terms of the risk of lower limb edema and GI upset. Conclusion: Our meta‐analysis found that amlodipine significantly increases cardiac T2* and decreases MIC, hence decreasing the incidence of cardiomyopathy‐related iron overload in thalassemia patients.