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CaEDTA vs CaEDTA plus BAL to treat children with elevated blood lead levels
1Division of General Academic Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, OH 44106.
Insights
For children with moderate lead levels, CaEDTA alone is more effective and less toxic than CaEDTA plus BAL. The combination therapy showed increased side effects and no improved long-term lead reduction.
Area of Science:
- Pediatric toxicology
- Chelation therapy
- Environmental health
Background:
- Lead poisoning in children is a significant public health concern.
- Chelation therapy is used to reduce lead levels in the body.
- Calcium disodium ethylenediaminetetraacetic acid (CaEDTA) and dimercaprol (BAL) are chelating agents.
Purpose of the Study:
- To compare the effectiveness and toxicity of CaEDTA alone versus CaEDTA plus BAL in children with moderate lead exposure.
- To evaluate the impact of combination therapy on lead levels and zinc protoporphyrin (ZnP) concentrations.
Main Methods:
- Retrospective study of 72 children with blood lead levels between 2.41 mumol/L (50 micrograms/dL) and 2.90 mumol/L (60 micrograms/dL).
- Comparison of outcomes between children treated with CaEDTA alone and those treated with CaEDTA plus BAL.
- Analysis of lead levels, ZnP concentrations, treatment toxicity, and need for repeat chelation courses.
Main Results:
- Children receiving CaEDTA plus BAL had higher initial ZnP levels.
- Combination therapy led to a significantly increased incidence of vomiting and abnormal liver function tests.
- CaEDTA alone resulted in a greater mean percentage decrease in lead levels at 1–3 weeks post-chelation (30.5% vs 18.1%).
- While combination therapy showed a greater ZnP decrease at 4–8 months, there was no difference in lead level reduction.
- Children receiving both drugs required more repeat chelation courses within six months.
Conclusions:
- Adding BAL to CaEDTA for treating children with moderate lead levels (2.41–2.90 mumol/L) increases toxicity.
- Combination therapy does not appear to offer superior lead reduction or prevent repeat chelation within six months.
- CaEDTA monotherapy may be a more favorable treatment option due to reduced toxicity and comparable efficacy.
Abstract:
The effectiveness of CaEDTA alone vs CaEDTA plus BAL was compared retrospectively in a group of 72 children with lead levels between 2.41 mumol/L (50 micrograms/dL) and 2.90 mumol/L (60 micrograms/dL). The children who received both drugs had higher median zinc protoporphyrin (ZnP) concentrations at the initiation of therapy than children who received CaEDTA alone (160 micrograms/dL vs 96 micrograms/dL, p less than .01). There was a significantly increased incidence of vomiting and abnormal liver-function test results in the children who received both drugs. The children who received CaEDTA alone had a greater percent mean fall in lead level at one to three weeks postchelation (30.5% vs 18.1%, p less than .05). Children who received both CaEDTA and BAL had a greater percent decrease in ZnP at four to eight months postchelation, but there was no difference in percent decrease in lead levels. Children who received both drugs also had a greater number of repeat courses of chelation by six months. The addition of BAL to CaEDTA for treatment of children with lead levels of 2.41 mumol/L (50 micrograms/dL) to 2.90 mumol/L (60 micrograms/dL) produced greater toxicity and does not seem to prevent repeat chelations within six months.