Liver iron and fibrosis during long‐term treatment with deferiprone in Swiss thalassaemic patients

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Abstract
Serum ferritin levels, hepatic histology and iron concentration were studied in a ‘veteran’ group of seven Swiss β‐thalassaemic patients after 93–99 months of treatment with the oral iron chelator deferiprone (L1), and another four patients who had received 54–82 months of L1 therapy. Despite continuous compliance, unexplained resurgence of serum ferritin levels occurred in 4/7 patients of the ‘veteran’ group after 4–5 years on L1. In three of these a concomitant increase of liver iron was also observed. Hepatic histology revealed significantly higher degrees of fibrosis in 6/11 hepatitis C (HC)‐positive patients (fibrosis scores 1–5, mean 3.0) than in the HC‐negative group (fibrosis score 0–2, mean 0.8). Two HC‐negative patients had no detectable fibrosis after 98 and 93 months on deferiprone. Therefore the hepatic pathology in these patients cannot definitely be attributed as a side‐effect of deferiprone. Chronic active hepatitis C and the accumulation of iron are the major causative factors to be considered.