Related Experiment Videos
Children with moderately elevated lead levels: is chelation with DMSA helpful?
1Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
Insights
Environmental remediation is recommended for children with elevated blood lead levels. DMSA (2,3 dimercaptosuccinic acid) treatment did not significantly improve long-term blood lead levels in this study.
Area of Science:
- Pediatric Environmental Health
- Toxicology
- Clinical Pharmacology
Background:
- Childhood lead exposure remains a significant public health concern.
- Elevated blood lead levels (BPb) in children are associated with adverse neurodevelopmental outcomes.
- Environmental remediation is a cornerstone of lead exposure management.
Purpose of the Study:
- To evaluate the effectiveness of DMSA (2,3 dimercaptosuccinic acid) in conjunction with environmental remediation for children with BPb levels of 30-45 µg/dL.
- To compare DMSA treatment against a placebo, both combined with environmental remediation.
- To assess the impact of DMSA on BPb levels at 1 and 6 months post-intervention.
Main Methods:
- A double-blind, placebo-controlled trial was conducted.
- 39 children aged 2-5 years with BPb levels between 30-45 µg/dL were randomized.
- Participants received either one course of DMSA or a placebo, alongside environmental remediation.
Main Results:
- Mean BPb levels at study entry were similar between groups (Placebo: 33.0 µg/dL, DMSA: 34.9 µg/dL).
- At 1 month, mean BPb levels were lower in the DMSA group (27.4 µg/dL) compared to placebo (33.2 µg/dL), but the difference was not statistically significant (p=0.16).
- At 6 months, mean BPb levels were 25.1 µg/dL for placebo and 28.8 µg/dL for DMSA, also not statistically significant (p=0.06).
Conclusions:
- DMSA treatment, when combined with environmental remediation, did not lead to statistically significant long-term reductions in blood lead levels in children within the studied BPb range.
- Environmental evaluation and remediation are essential for all children with elevated BPb levels.
- DMSA is not shown to be an effective adjunct therapy for improving long-term blood lead levels in this population.
Abstract:
This study evaluates the effectiveness (use under routine circumstances) of DMSA (2,3 dimercaptosuccinic acid) and environmental remediation as compared with placebo and environmental remediation on children with blood lead (BPb) levels of 30-45 micrograms/dL (1.45-2.17 mumol/L). The endpoints were BPb at 1 month and 6 months after study entry. This double-blind placebo-controlled trial involved 39 children aged 2-5 years, who were randomized to one course of DMSA or placebo. The mean BPb levels of the two groups at study entry were similar, placebo group 33.0 micrograms/dL (1.59 mumol/L) and the DMSA group 34.9 micrograms/dL (1.68 mumol/L). At 1 month (the end of treatment) the mean BPb levels of the two groups were: placebo group 33.2 micrograms/dL (1.60 mumol/L) and the DMSA group 27.4 micrograms/dL (1.32 mumol/L), p = 0.16. At 6 months, the mean BPb levels were 25.1 micrograms/dL (1.21 mumol/L) for the placebo group and 28.8 micrograms/dL (1.39 mumol/L) for the DMSA-treated group, p = 0.06. Neither of these differences is statistically significant. All children with BPb, in the range studied here, should receive environmental evaluation and remediation; DMSA does not improve long-term blood lead levels.