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Amlodipine as Adjuvant Therapy to Current Chelating Agents in Reducing Iron Overload in Thalassemia Major: Systematic Review, Meta-analysis and Simulation of Future Studies
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  • Sherief Ghozy,
  • Amr Ebied,
  • Muhammed Khaled Elfaituri,
  • Mostafa Ebraheem Morra,
  • Osama Gamal Hassan,
  • Ahmed Alhusseiny,
  • Alzhraa Salah Abbas,
  • Nourin Ali Sherif,
  • Juliano Lara Fernandes,
  • Nguyen Tien Huy
Sherief Ghozy
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Amr Ebied
Egyptian National Blood Transfusion Services
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Muhammed Khaled Elfaituri
University of Tripoli Faculty of Medicine
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Mostafa Ebraheem Morra
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Osama Gamal Hassan
University of South Valley Faculty of Oral and Dental Medicine
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Ahmed Alhusseiny
Mansoura University Faculty of Medicine
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Alzhraa Salah Abbas
Minia University
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Nourin Ali Sherif
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Juliano Lara Fernandes
Jose Michel Kalaf Research Institute
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Nguyen Tien Huy
Nagasaki Daigaku
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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.