Amlodipine As Adjuvant Therapy To Current Chelating Agents For Reducing Iron Overload In Thalassaemia Major: A Systematic Review, Meta-Analysis And Simulation Of Future Studies

Background and Objectives Iron overload in thalassaemia is a crucial prognostic factor and a major cause of death due to heart failure or arrhythmia. Therefore, previous research has recommended amlodipine as an auxiliary treatment to current chelating agents for reducing iron overload in thalassaemia patients.Materials and Methods A systematic review and meta-analysis of the results of three randomized clinical trials evaluating the use of amlodipine in thalassaemia patients through 12 databases were carried out.Results Our final cohort included 130 patients. Insignificant difference in decreasing liver iron concentrations was found between amlodipine and control groups {weighted mean difference = -0 center dot 2, [95% confidence interval = (-0 center dot 55-0 center dot 15), P = 0 center dot 26]}. As regards serum ferritin, our analysis also showed no significant difference in serum ferritin between amlodipine and control groups {weighted mean difference [95% confidence interval = -0 center dot 16 (-0 center dot 51-0 center dot 19), P = 0 center dot 36]}. Similarly, there was insignificant difference in cardiac T2* between amlodipine and control groups {weighted mean difference [95% confidence interval = 0 center dot 34 (-0 center dot 01-0 center dot 69), P = 0 center dot 06]}.Conclusions Despite the growing evidence supporting the role of amlodipine in reducing iron overload in thalassaemia patients, our meta-analysis did not find that evidence collectively significant. The results of our simulation suggest that when more data are available, a meta-analysis with more randomized clinical trials could provide more conclusive insights.