Amlodipine as Adjuvant Therapy to Current Chelating Agents in Reducing
Iron Overload in Thalassemia Major: Systematic Review, Meta-analysis and
Simulation of Future Studies
Abstract
Iron overload in thalassemia is a substantial prognostic factor and has
been a leading cause of death due to heart failure or fatal arrhythmia.
Recent studies have recommended administering amlodipine as an adjuvant
remedy to current chelating agents for reducing iron overload. A
systematic search was carried out through 12 databases. Randomized
clinical trials (RCTs) reporting the use of amlodipine in thalassemia
patients were included for meta-analysis. Our study included three RCTs
including 130 patients. Insignificant difference was found between
amlodipine and control groups in reducing liver iron concentration (LIC)
[mean differences (MD) (95% confidence interval (CI)) = -0.20 (-0.55
– 0.15), p = 0.26]. As regards serum ferritin, our analysis showed no
significant difference between amlodipine and control groups [MD (95%
CI) = -0.16 (-0.51 – 0.19), p = 0.36]. There was insignificant change
in heart T2* between amlodipine and control groups [MD (95% CI) =
0.34 (-0.01 – 0.69), p = 0.06]. Despite the growing evidence from
animal and human studies, the role of amlodipine in reducing iron
overload in thalassemia patients is unpretentious. The results of
simulation imply that when more data are available, a new meta-analysis
could provide a more conclusive answer.