Kyaw · International journal of hematology-oncology and stem cell research 2025 · systematic review of randomized controlled trials · n=14 studies

Synergic Treatment of Plant-Based Antioxidants with Iron Chelators for Iron Overload in Transfusion-Dependent-Thalassemia Patients: A Systematic Review.

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Level 1 - systematic review of randomized trials

Systematic review of randomized controlled trials

PubMed 41281788 · doi:10.18502/ijhoscr.v19i3.19289 · record verified 2026-08-29

What was done

A systematic review was conducted across 14 randomized clinical trials evaluating the combined use of plant-based antioxidants and standard iron chelators for managing iron overload and oxidative stress in transfusion-dependent thalassemia patients. The included trials spanned young and adult populations and utilized various trial designs, including parallel double-blind, triple-blind, simple randomized, and crossover formats. Outcomes evaluated included markers of iron metabolism (total iron, ferritin, total iron-binding capacity), oxidative stress (total antioxidant capacity, malondialdehyde), and hepatic function (AST, ALT).

What was found

No pooled numerical effect sizes or confidence intervals were reported in the abstract. Among the 14 included trials, 9 reported a significant reduction in iron overload, 8 observed marked decreases in oxidative stress markers, and 5 demonstrated reduced liver enzyme levels. Specifically, supplementation with silymarin, green tea, and grape seed extract led to notable reductions in total iron, ferritin, AST, and ALT, along with increases in total iron-binding capacity. In contrast, trials evaluating quercetin and curcumin supplementation failed to show statistically significant differences compared to control groups.

Why it matters

This review indicates that specific antioxidant adjuncts, particularly silymarin, green tea, and grape seed extract, may enhance conventional iron chelation therapy by simultaneously targeting iron accumulation, oxidative stress, and liver injury in transfusion-dependent thalassemia.

Limits

The abstract reports no pooled quantitative data, confidence intervals, or total participant sample size. The included trials featured significant clinical heterogeneity in antioxidant types, dosages, formulations, study designs, and participant age groups. Long-term clinical outcomes, safety endpoints, and potential supplement-drug interactions were not detailed in the abstract.

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