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All Journal Medical Journal of Indonesia Jurnal Ilmu dan Teknologi Kesehatan Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Cermin Dunia Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Iris Rengganis
Faculty of Medicine Universitas Indonesia, Jakarta
Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Health Professions Medicine & Pharmacology Public Health

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Efficacy of fetal hemoglobin inducers in adult transfusion-dependent beta-thalassemia patients: a systematic review and meta-analysis Naufal, Muhammad Afif; Fauzi, Ahmad; Rengganis, Iris
Medical Journal of Indonesia Vol. 34 No. 4 (2025): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257796

Abstract

BACKGROUND Patients with transfusion-dependent beta-thalassemia (TDBT) face risks of iron overload, which also burdens national expenditures in Indonesia. Elevated fetal hemoglobin (HbF) expression is associated with reduced blood transfusion dependency. This study aimed to assess the efficacy and safety profile of HbF inducers as adjuvant therapy for adult patients with TDBT and appraise its feasibility for Indonesian patients. METHODS This study analyzed 7 trials of HbF inducers, such as hydroxyurea, thalidomide, butyrate, and decitabine, in 382 adult participants (mean age >16), including 28 patients with non-TDBT. Outcomes assessed included hemoglobin (Hb) levels, transfusion needs, and adverse events (AEs). Studies were sourced from PubMed, Cochrane, Embase, and individual searches. The standardized mean difference (SMD) was used as the primary effect size. The protocol was registered in PROSPERO (CRD4202454646368). RESULTS High heterogeneity was observed, with HbF inducers associated with a significant decrease in transfusion needs (SMD = −0.88; 95% confidence interval [CI] = −1.37 to −0.26); I2 = 79%, P✗2<0.01). No significant change in Hb levels was found (SMD = 0.11; 95% CI = −0.69 to 0.91; I2 = 90%, P✗2<0.01). The most common AEs were transaminitis and cytopenias, which were tolerable and alleviated upon dose cessation. CONCLUSIONS HbF induction agents can be used as adjuvant therapy for TDBT, considering their cost-effectiveness, efficacy, and safety profiles.
Co-Authors -, Lisnawati -, Yudhistira Adhiatma, Kresna Adityo Susilo, Adityo Agiananda, Feranindhya Agus Joko Susanto, Agus Joko Alimuddin, Suriani Alimuddin, Suriani Cleopas M Rumende, Cleopas M Cleopas Martin Rumende E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Estie Puspitasari, Estie Evy Yunihastuti Fauzi Ahmad Muda Heri Wibowo Ikhwan Rinaldi Irmia Kusumadewi Joedo Prihartono Kuntjoro Harimurti Kwarta, Cytyta Putri Lukman Edwar Marcellus Simadibrata Murdani Abdullah Naufal, Muhammad Afif Nuraeni, Hanny Siti Parhusip, Santi Sumihar Rumondang Pringgodigdo Nugroho, Pringgodigdo Priya Darsini, Indira Putro, Agung W Rambe, Dirga S. Roy Akur Pandapotan, Roy Akur Rudi Putranto Rumende, Cleopas M. Siti Setiati Suhendro Suwarto, Suhendro Sukartini, Ninik Susanto, Agus J. Suzanna Immanuel Tri Juli Edi Tarigan