The Impact of Chelation
Compliance in Health Outcome and Health Related Quality of Life in
Thalassaemia Patients: A Systematic Review
Lee Wan Jin1;
Nurul Ain Mohd
Tahir1*; Chun Geok Ying1; Shu Chuen
Li2
1Centre of
Quality Management of Medicines, Faculty of Pharmacy, Universiti
Kebangsaan Malaysia, Kuala Lumpur, Malaysia
2School of
Biomedical Sciences and Pharmacy, College of Health, Medicine and
Wellbeing, University of Newcastle, New South Wales, Australia
Correspondence:
nurulainmt@ukm.edu.my
Understanding consequences of poor chelation compliance is crucial given
the enormous burden of
post-transfusional iron overload complications. We systematically
reviewed iron-chelation therapy (ICT) compliance, and the relationship
between compliance with health outcome and health-related quality of
life (HRQoL) in thalassaemia patients.
Several reviewers performed
systematic search strategy of literature through PubMed, Scopus, and
EBSCOhost. The preferred reporting items of systematic reviews and
meta-analyses (PRISMA) guidelines were followed. Of 4917 studies, 20
publications were included. The ICT compliance rate ranges from 20.93%
to 75.3%. It also varied per agent, ranging from 48.84-85.1% for
desferioxamine, 87.2-92.2% for deferiprone and 90-100% for
deferasirox. Majority of studies (N=10/11, 90.91%) demonstrated
significantly negative correlation between compliance and serum
ferritin, while numerous studies revealed poor ICT compliance linked
with increased risk of liver disease (N=4/7, 57.14%) and cardiac
disease (N=6/8, 75%), endocrinologic morbidity (N=4/5, 90%), and lower
HRQoL (N=4/6, 66.67%). Inadequate compliance to ICT therapy is common.
Higher compliance is correlated with lower serum ferritin, lower risk of
complications, and higher HRQoL. These findings should be interpreted
with caution given the few numbers of evidence.
Keywords: compliance, iron chelation therapies, thalassaemia,
HRQoL, iron overload