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Improved Care for Iron Overload in Sickle Cell Anemia

Insights From:Morey Blinder, MD Washington University
Published: Thursday, Dec 03, 2015


For patients who are being switched from the older (Exjade) to the newer formulation of deferasirox (Jadenu), there are some considerations in terms of titrating up to the fully approved dosage. The starting dosage of Jadenu should be 70% that of Exjade and can be titrated up to the full dosage once the patient is tolerating therapy well, according to Morey Blinder, MD. For iron chelation therapy-naive patients, Jadenu should be started at 14 mg/kg of body weight daily, which can be adjusted to the nearest whole tablet and based on the patient’s chelation requirements and tolerability.

Adherence to therapy was traditionally a challenge with the Exjade formulation, particularly in patients with sickle cell disease. There are several ways to assess adherence to therapy, says Blinder. Honest communication about adherence builds trust and bonding with the patient, he says. Other ways to assess adherence include understanding the frequency of prescription refills and assessing the patient’s ferritin level (although less accurate). Fortunately, says Blinder, the introduction of Jadenu has obviated many of the problems with adherence.

Treatment of sickle cell anemia is evolving over time for the better, even in the absence of major therapeutic advances. From his own adult patients, Blinder has heard, universally, that care has become more streamlined and effective over the past 20 years. This is in large part attributed to 2 disease-modifying therapies, transfusion with chelation management and hydroxyurea.
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For patients who are being switched from the older (Exjade) to the newer formulation of deferasirox (Jadenu), there are some considerations in terms of titrating up to the fully approved dosage. The starting dosage of Jadenu should be 70% that of Exjade and can be titrated up to the full dosage once the patient is tolerating therapy well, according to Morey Blinder, MD. For iron chelation therapy-naive patients, Jadenu should be started at 14 mg/kg of body weight daily, which can be adjusted to the nearest whole tablet and based on the patient’s chelation requirements and tolerability.

Adherence to therapy was traditionally a challenge with the Exjade formulation, particularly in patients with sickle cell disease. There are several ways to assess adherence to therapy, says Blinder. Honest communication about adherence builds trust and bonding with the patient, he says. Other ways to assess adherence include understanding the frequency of prescription refills and assessing the patient’s ferritin level (although less accurate). Fortunately, says Blinder, the introduction of Jadenu has obviated many of the problems with adherence.

Treatment of sickle cell anemia is evolving over time for the better, even in the absence of major therapeutic advances. From his own adult patients, Blinder has heard, universally, that care has become more streamlined and effective over the past 20 years. This is in large part attributed to 2 disease-modifying therapies, transfusion with chelation management and hydroxyurea.
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