Comparative effects of three iron chelation therapies on the quality of life of greek patients with homozygous transfusion-dependent Beta-thalassemia

Abstract

This prospective study assessed the quality of life of patients with homozygous transfusion-dependent beta-thalassemia in Greece receiving three different iron chelation treatments. Patients enrolled were receiving one of the following chelation therapies: deferoxamine (n = 21), deferasirox (n = 75), or deferoxamine in combination with deferiprone (n = 39). The three groups were compared in terms of their quality of life, satisfaction and adherence to treatment, control of their health, and self-esteem through the completion of five questionnaires. A higher percentage of patients receiving deferoxamine felt that their treatment negatively influenced their body and skin appearance and limited their ability to work, attend school, and perform daily tasks (P = 0.0066). The adherence to treatment rate and self-esteem were the lowest in the deferoxamine group (P < 0.05). The deferoxamine group also had the lowest physical component summary score in the SF-36 questionnaire (P = 0.014). This study suggests that the quality of life of beta-thalassemia patients receiving chelation therapy is dependent on the type of iron chelation treatment they receive. The study provides insight into important factors associated with the quality of life of these patients, which are essential for developing a more suitable clinical support team and counseling in order to maximize the treatment benefits for these patients in daily clinical practice.

Figure 1

Quality of life for patients with the three different chelation treatments according to the SF-36 scale. The physical (PCS) and mental (MCS) component summary scores were calculated from data for 120 patients that had completed all parts of the questionnaire. These included 70 receiving DFX, 33 receiving DFO, and 17 receiving DFO + DFP. A statistically significant difference was noted between the chelation treatments for the PCS score (univariate analysis, P = 0.014). Pairwise comparisons demonstrated that both DFX and DFO + DFP were statistically different from DFO, but they were not different from each other. The MCS score did not differ among the chelation therapies (P = 0.08).

Figure 2

Effect of iron chelation therapy on the ability of the beta-thalassemia patients to perform their daily tasks. A statistically significant difference was noted among the three groups (P = 0.0066). Patients receiving DFO were more limited.

Figure 3

Adherence of patients to their treatment. The patients were asked to rate their adherence to treatment between five categories including the choices “always adhere,” “sometimes adhere” or “forget my treatment.” A statistically significant difference was noted among the three groups (P < 0.001). Adherence was the lowest among those receiving DFO.

Figure 4

Annoyance from the length of treatment. Patients were asked to describe the extent of annoyance they felt from the length of their treatment. They could chose among 5 severity levels ranging from “major annoyance” to “none at all.” A statistically significant difference was noted among the three groups (P < 0.0293). Those receiving DFO reported that their treatment was hard or very hard to receive more often than patients of the other two groups.

Figure 5

Ease of receiving treatment. Patients were asked to rate the difficulty of receiving their treatment on a 5-point scale ranging from very hard to very easy. A statistically significant difference was noted among the three groups (P = 0.0289). Those receiving DFO had the highest frequency of reporting that their the treatment was hard or very hard to receive and the lowest frequency of reporting that their treatment was easy or very easy to receive.