A randomized controlled trial evaluating the effects of amlodipine on myocardial iron deposition in pediatric patients with thalassemia major

Arwa Khaled,1 Hoda A Salem,2 Dina A Ezzat,3 Hadeel M Seif,4 Hoda Rabee51Department of Clinical Pharmacy, Beni-Suef University Hospital, Beni-Suef University, Beni Suef, 62515, Egypt; 2Department of Clinical Pharmacy, Faculty of Pharmacy, Al–azhar University, Girl Branch, Cairo, 12655, Egypt; 3Department of Pediatrics and Pediatric Hematology, Faculty of Medicine, Beni-Suef University, Beni Suef, 12568, Egypt; 4Department of Radiology, Faculty of Medicine, Cairo University Cairo, Cairo 8582, Egypt; 5Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, EgyptBackground: Mortality rates increase due to iron deposition in the cardiac muscles of thalassemia major (TM) patients. Iron overload cardiomyopathy could be treated with a combination therapy of an iron chelator and an L-type calcium channel blocker. We designed a randomized controlled study to assess the potential of amlodipine, alongside chelation, in reducing myocardial iron concentration in TM patients compared with a placebo.Objectives: This study aims to estimate the change in myocardial iron concentration (MIC) determined by magnetic resonance imaging after 6months of treatment with amlodipine, as well as measuring the changes in the secondary outcomes (liver iron concentration (LIC), serum ferritin level (SF), and left ventricle ejection fraction (LVEF)) of study participants.Methods: A single, randomized, placebo-controlled trial was performed in 40 β-Thalassemia major patients aged between 6 and 20years old, who received either oral amlodipine 2.5–5mg/day or a placebo, in addition to a Deferasirox chelation regimen in a 1:1 allocation ratio.Results: After 6months, a significant reduction was noted in the MIC of patients receiving amlodipine (n=20), compared with the patients receiving the placebo (n=20). At baseline, the mean was 0.76±0.11mg/g dry weight, while at 6months, the mean was 0.51±0.07mg/g dry weight (p