I think a mistake people make with the Exjade (Deferasirox) drugs, and Asunra is not a generic, as it is manufactured by Novartis India, while Desirox is made by Cipla and could be considered a generic, is expecting to see immediate results in the ferritin. From the very beginning, with the Exjade trial period, we have seen the same phenomenon over and over. Annie, from Hong Kong, was one of the first people I knew who participated in an Exjade trial. During the first year, her ferritin doubled. Her doctor told her not to be alarmed and that it would indeed come down. During her second year on Exjade, her ferritin level plummeted, just as her doctor had told her it would. We have to remember a very important fact. The iron in serum ferritin is sequestered by the body in the ferritin protein, and it can do no harm while it is isolated in the ferritin. Ferritin levels also do not necessarily correlate with the true iron load found in the organs. Ferritin levels also change rapidly during any bacterial or viral infection, as the body moves iron into the ferritin, so the iron is not readily available to feed the bacteria or virus. This is a normal mechanism, but it often alarms patients and parents, who would otherwise not be aware of the changes, except for the frequent ferritin testing. We have seen over and over, that Exjade apparently works to get iron out of the organs first, and that its effect on ferritin levels comes later. This is probably why the combination of Exjade and desferal is showing such good results. While Exjade is reducing tissue iron, desferal is mopping up the iron in the blood, that is found as ferritin and even free iron (the most dangerous iron).
I would highly recommend that no form of Deferasirox be stopped unless it has been used for a minimum of two years at a 30 mg/kg dose, unless the side effects are such that continuing the drug is not feasible. Patience is required, as is the recognition that maintenance doses will not lower the ferritin in iron loaded patients. As long as you know the source of your Deferasirox supply is legitimate and there is no possibility of it being a counterfeit drug, there is no reason to suspect the other forms of Deferasirox to be any less effective than Exjade itself. And those with very high ferritin levels should also consider a dose of up to 40 mg/kg daily. I would also suggest splitting the dose into two and taking it twice daily, if your results are slow to materialize, as further testing has shown that many patients are not getting 24 hour chelation from a once daily dose.