Therapeutic effects of deferoxamine and silymarin versus deferoxamine alone in β-thalassemia major based on findings of liver MRI

Abstract

• BACKGROUND: Thalassemia is an inherited disorder in which repeated blood transfusion is needed. This causes accumulation of iron in various organs. Silymarin is a natural medicinal plant that has been used for centuries in the treatment of liver depositions. In this study, magnetic resonance imaging (MRI) of liver, which has high accuracy in measuring liver iron concentration (LIC), was used to evaluate the effects of silymarin (Legalon) as an iron-chelating agent. 
• METHODS: In this double-blind randomized clinical-trial study, 48 thalassemic patients were enrolled during a period of 6 months. In order to evaluate the efficacy of Legalon on LIC, the control group was treated with deferoxamine and placebo tablets while the case group received a combination of deferoxamine and silymarin. MRI was performed for all patients before and after the intervention to determine liver iron using Gandon's protocol. 
• RESULTS: Overall, 37 patients, including 22 controls and 15 cases, completed the study. The mean concentrations of liver iron at baseline were 290 ± 62 µmol/g and 328 ± 27.8 µmol/g in the control and case groups, respectively. The mean liver iron concentrations after 6 months of intervention were 290.4 ± 65.4 µmol/g and 334.6 ± 27.9 µmol/g in the control and case groups, respectively. No group experienced a significant difference in LIC change before and after the 6-month trial (p = 0.43). 
• CONCLUSIONS: Administration of silymarin did not cause significant changes in liver iron concentration. Evaluating a longer course of treatment with this drug is thus suggested.
• KEYWORDS: Beta-Thalassemia; Magnetic Resonance Imaging; Silymarin, Deferoxamine