Safety and tolerability of deferoxamine mesylate in patients with acute intracerebral hemorrhage.

Abstract

BACKGROUND AND PURPOSE:

Treatment with the iron chelator, deferoxamine mesylate (DFO), improves neurological recovery in animal models of intracerebral hemorrhage (ICH). We aimed to evaluate the feasibility, safety, and tolerability of varying dose-tiers of DFO in patients with spontaneous ICH, and to determine the maximum tolerated dose to be adopted in future efficacy studies.

METHODS:

This was a multicenter, phase-I, dose-finding study using the Continual Reassessment Method. DFO was administered by intravenous infusion for 3 consecutive days, starting within 18 hours of ICH onset. Subjects underwent repeated clinical assessments through 90 days, and computed tomography neuroimaging pre- and post-drug-administration.

RESULTS:

Twenty subjects were enrolled onto 5 dose tiers, starting with 7 mg/kg per day and ending with 62 mg/kg per day as the maximum tolerated dose. Median age was 68 years (range, 50-90); 60% were men; and median Glasgow Coma Scale and National Institutes of Health Stroke Scale scores on admission were 15 (5-15) and 9 (0-39), respectively. ICH location was lobar in 40%, deep in 50%, and brain stem in 10%; intraventricular hemorrhage was present in 15%. DFO was discontinued because of adverse events in 2 subjects (10%). Six subjects (30%) experienced 12 serious adverse events, none of which were drug-related. DFO infusions were associated with mild blood-pressure-lowering effects. Fifty percent of patients had modified Rankin scale scores ≤2, and 39% had modified Rankin scale scores of 4 to 6 on day 90; 15% died.

CONCLUSIONS:

Consecutive daily infusions of DFO after ICH are feasible, well-tolerated, and not associated with excessive serious adverse events or mortality. Our findings lay the groundwork for future studies to evaluate the efficacy of DFO in ICH.

• Authors: Magdy Selim, Sharon Yeatts, Joshua N Goldstein, Joao Gomes, Steven Greenberg, Lewis B Morgenstern, Gottfried Schlaug, Michel Torbey, Bonnie Waldman, Guohua Xi, Yuko Palesch, Deferoxamine Mesylate in Intracerebral Hemorrhage Investigators
• Journal: Stroke (Stroke) Vol. 42 Issue 11 Pg. 3067-74 (Nov 2011) ISSN: 1524-4628 [Electronic] United States
• PMID: 21868742 (Publication Type: Clinical Trial, Phase I, Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Chemical References

• Deferoxamine

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Cerebral Hemorrhage (drug therapy, pathology)
• Cohort Studies
• Deferoxamine (administration & dosage, adverse effects)
• Female
• Follow-Up Studies
• Humans
• Hypotension (chemically induced)
• Infusions, Intravenous
• Male
• Middle Aged