Effect of succimer on growth of preschool children with moderate blood lead levels.

Abstract

Growth deficits associated with lead exposure might be ameliorated by chelation. We examined the effect of succimer on growth in 780 children 12-33 months old who had blood lead levels of 20-44 µg/dL and were randomized to receive up to three 26-day courses of succimer or placebo in a multicenter, double-blind trial. The difference in changes in weight and height between succimer and placebo groups at 1-34 months was calculated by fitting cubic splines. The difference in height change in children on succimer compared with placebo was -0.27 cm [95% confidence interval (95% CI), -0.42 to -0.11] from baseline to 9 months, when 99% of children had completed treatment, and -0.43 cm (95% CI, -0.77 to -0.09) during 34 months of follow-up. Similar differences in weight gain were not statistically significant. Although succimer lowers blood lead in moderately lead-poisoned children, it does not have a beneficial effect on growth and may have an adverse effect.

Dimercaptosuccinic acid (succimer; DMSA) in inorganic lead poisoning

“…63 DMSA also had no effect on blood pressure. 61 There was, however, an apparent beneficial effect on locomotor function in terms of obstacle crossing and normal walking among 80 treated children in a subset of 161 children from the overall study who were further assessed with regard to posture and balance.…”

“…Several papers [57][58][59][60][61][62][63][64] have been published based on a large trial involving multiple clinical sites across North America, in which 780 children aged between 12 and 33 months with blood lead concentrations between 20 and 44 μg/dL were randomized to receive either placebo (n = 384) or up to three 26-day courses of oral DMSA (30 mg/kg/day for 7 days then 20 mg/kg/day for 19 days, n = 396). Blood lead concentrations were measured on days 7, 28, and 42 after the beginning of each course of DMSA.…”

Chelators as Antidotes of Metal Toxicity: Therapeutic and Experimental Aspects

“…Recent clinical trials showed that meso-DMSA treatment in preschool children with moderately elevated blood lead levels (20 to 44 µg/dL) did not have beneficial effect on growth, and did not improve the cognitive, behavioral, or neurophysiological functions [178][179][180]. Until new evidence emerges, it is recommended that chelation treatment is generally not justified in children with blood lead levels below 45 µg/dL [179].…”

Therapeutic potentials of combined use of DMSA with calcium and ascorbic acid in the treatment of mild to moderately lead intoxicated mice

“…Despite growing concern regarding the detrimental effects on mild to moderately lead poisoned children and adults, pharmacological treatment is controversial (Dietrich et al 2004, Peterson et al 2004). Meso-2,3-dimercaptosuccinic acid (DMSA), is a water-soluble, sulfhydrylcontaining compound which is an effective oral chelator of heavy metals, and was identified as an effective antidote to heavy metal poisoning over 50 years ago (Miller 1998).…”