Author: Apotex Europe BV


Long information

What is it?

Ferriprox is a medicine that contains the active substance deferiprone. It is available as white, capsule-shaped tablets (500 and 1,000 mg) and as an oral solution (100 mg/ml).

Table of Contents
What is it used for?
How is it used?
How does it work?
How has it been studied?
What benefits has it shown during the studies?
What is the risk associated?
Why has it been approved?

What is it used for?

Ferriprox is used to treat iron overload (an excess of iron in the body) in patients with thalassaemia major. This is an inherited disease in which patients are unable to make enough haemoglobin, the protein found in red blood cells that carries oxygen around the body. Ferriprox is used when deferoxamine (the standard treatment for iron overload) cannot be used or is inadequate.

The medicine can only be obtained with a prescription.

How is it used?

Ferriprox treatment should be started and maintained by a doctor who has experience in the treatment of patients with thalassaemia.

The usual dose of Ferriprox is 75 mg per kilogram body weight each day, divided into three separate doses. If the tablets are used, each dose is adjusted to the nearest half tablet. If the oral solution is used, the dose is adjusted to the nearest 2.5 ml. Doses above 100 mg/kg a day are not recommended because of a potentially increased risk of side effects. The doctor may adjust the dose of Ferriprox depending on the patient?s response, which should be measured every two to three months with blood tests. The doctor may interrupt treatment if iron levels in the body get too low.

Patients taking Ferriprox, or their carers, must be given a reminder card that reminds the patient how to take the medicine safely.

For more information, see the summary of product characteristics (also part of the EPAR).

How does it work?

Patients with thalassaemia major need frequent blood transfusions. When patients receive repeated transfusions, the transfused red cells bring iron into the body. However, the body does not have a natural way of removing excess iron, so it builds up. Over time, the excess iron can damage important organs such as the heart or liver. The active substance in Ferriprox, deferiprone, is an ?iron chelator?. It attaches to iron in the body to form a compound that can be excreted by the body, mainly in the urine, and to a lesser extent in the stools. This helps to correct the iron overload and prevent damage due to excess iron.

How has it been studied?

Ferriprox was originally studied in three studies involving 247 patients over six years of age with thalassaemia major, with the main study comparing Ferriprox with deferoxamine in 71 patients over two years. The study was ?open label?, meaning that the doctor and patients knew which medicine they were using, because Ferriprox was given by mouth, whereas deferoxamine was given by subcutaneous infusion (a very slow injection under the skin) overnight. A later study compared treatment alternating Ferriprox and deferoxamine (five days? Ferriprox plus two days? deferoxamine each week) with continuous treatment with deferoxamine on its own, in 60 patients over 12 months.

In all of the studies, the main measure of effectiveness was the change in the levels of ferritin in the blood. Ferritin is a protein that stores iron in the body. The blood ferritin level indicates how much iron is being stored in the body.

What benefits has it shown during the studies?

In the initial study comparing Ferriprox with deferoxamine, the average blood ferritin levels were similar in the two treatment groups. However, the average iron concentration in the liver of Ferriprox-treated patients seemed to increase more than in deferoxamine-treated patients.

In the alternating treatment study, the treatment schedule combining Ferriprox for five days with deferoxamine for two days reduced blood ferritin levels to the same extent as deferoxamine taken on its own. However, there were too few patients in the study to prove whether such a schedule is as effective as deferoxamine taken on its own or not.

What is the risk associated?

The most common side effects with Ferriprox (seen in more than 1 patient in 10) are reddish-brown urine (showing that iron is being excreted), nausea (feeling sick), abdominal pain (stomach ache) and vomiting. A less common but serious side effect is agranulocytosis (very low levels of granulocytes, a type of white blood cell). For the full list of all side effects reported with Ferriprox, see the package leaflet.

Ferriprox should not be used in people who may be hypersensitive (allergic) to deferiprone or any of the other ingredients. Ferriprox must not be used in people who have had neutropenia (low levels of neutrophils, a type of white blood cell) repeatedly or agranulocytosis. Ferriprox must also not be used with medicines that might cause neutropenia or agranulocytosis. Ferriprox must not be used in women who are pregnant or breast-feeding.

Why has it been approved?

The CHMP decided that Ferriprox?s benefits are greater than its risks and recommended that it be given marketing authorisation.

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