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Safety and efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in children with elevated blood lead concentrations
1Lead Poisoning Program, The Kennedy Krieger Institute, Baltimore, Maryland 21205, USA.
Insights
Meso-2,3-dimercaptosuccinic acid (DMSA) safely reduced lead levels in children. However, lead levels rebounded post-treatment, highlighting the need for continued monitoring and environmental control to prevent reexposure.
Area of Science:
- Pediatric Toxicology
- Environmental Health
- Pharmacology
Background:
- Lead toxicity poses a significant health risk to children.
- Chelation therapy is a common approach to reduce lead levels.
Purpose of the Study:
- To assess the safety and efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in treating lead toxicity in young children.
- To evaluate DMSA's impact on blood lead concentration and essential metal levels.
Main Methods:
- An open-label study involving 59 children aged 12-65 months with elevated blood lead levels (25-66 microg/dL).
- Participants received oral DMSA for 26-28 day courses.
- Children resided in lead-safe housing or a clinical research unit during treatment.
Main Results:
- All completers showed significant reductions in blood lead levels during DMSA therapy.
- Blood lead concentrations rebounded to approximately 58% of pretreatment levels within 2-3 weeks post-therapy.
- No adverse reactions were attributed to DMSA; however, two patients experienced sharp increases due to reexposure to lead paint.
Conclusions:
- DMSA appears safe and effectively mobilizes lead from the body without affecting essential metals like zinc and copper.
- Continuous monitoring of blood lead levels during and after DMSA therapy is crucial due to the risk of reexposure.
- This study could not determine the long-term neurocognitive benefits of DMSA treatment.
Objective:
To evaluate the safety and efficacy of meso-2,3-dimercaptosuccinic acid in the treatment of children with lead toxicity.
Design:
This was an open-label study in 59 children 12-65-months old, with pretreatment whole-blood lead levels of 25-66 microg/dL, who received 116, 26-28 day courses of oral dimer-captosuccinic acid, while residing either in the Pediatric Clinical Research Unit of the Johns Hopkins Hospital or in lead-safe housing during the outpatient portion of the study.
Results:
All, who completed the study, showed sharp decreases in blood lead concentration during therapy, but 2-3 weeks following completion of drug therapy, blood lead concentration rebounded to an average of 58% (23 microg Pb/dL of whole blood) of their average pretreatment blood lead concentration (40 microg Pb/dL of whole blood). There were no adverse reactions attributable to dimercaptosuccinic acid; however, 2 of the 59 patients were reexposed to defective lead paint and experienced sharp increases in blood lead concentration while on therapy. In one instance, the child's blood lead concentration increased from 20 to 90 microg Pb/dL whole blood in 1 week. Other unexpected events were discussed in the text.
Conclusions:
Dimercaptosuccinic acid is apparently safe and does mobilize lead into the urine, but not the essential metals, zinc and copper. Reexposure is always a danger; therefore, all children, while on therapy, should be monitored for their blood lead concentration at weekly intervals during and immediately after therapy. No conclusions can be drawn from this study regarding long-term beneficial effects, if any, of this drug on late neurocognitive outcome.
