Children with moderately elevated lead levels: is chelation with DMSA helpful?

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.