An open-label trial of the efficacy of 15% aluminum chloride in 2% salicylic acid gel base in the treatment of moderate-to-severe primary axillary hyperhidrosis

Primary focal hyperhidrosis (HH) is a chronic disorder of excessive sweating. A single-center, open-label study was performed to determine the efficacy and safety of 15% aluminum chloride (AC) in 2% salicylic acid gel base (SAGB) Hydrosal in adults with moderate-to-severe primary axillary HH. Thirty subjects were given 15% AC in 2% SAGB to apply to their bilateral axillae nightly for the first week, then twice-weekly application as tolerated. The primary objective was change in mean Hyperhidrosis Disease Severity Score (HDSS) score from baseline to week 4. Participants who achieved an HDSS score < 2 were designated as "responders." Mean change in HDSS from baseline to week 4 was 1.32 (p = 0.0001). At week 4, 21 of 29 (72%) were responders, and at week 12, 18 of 25 (72%) were responders. Based on these results, 15% AC in 2% SAGB may be an effective, high-strength AC topical therapy for treatment of patients with moderate-to-severe axillary HH.

MF-101, an estrogen receptor beta agonist for the treatment of vasomotor symptoms in peri- and postmenopausal women

During peri- and postmenopausal stages, the majority of women experience moderate-to-severe vasomotor symptoms, such as hot flashes and night sweats, that interfere with sleep and reduce quality of life. Estrogen alone or in combination with a progestagen has been the standard therapy for such vasomotor symptoms; however, this therapeutic regimen is associated with severe side effects, such as breast cancer or cardiovascular events. To provide a better treatment option for menopausal women, Bionovo Inc is developing the estrogen receptor (ER)beta-selective agonist MF-101. Selective ER agonists can stimulate either ERalpha or ERbeta and induce tissue-specific estrogen-like effects, thus providing a safer alternative to conventional hormone therapy. MF-101 is derived from 22 herbs that are traditionally used in Chinese medicine for the treatment of menopausal symptoms. MF-101 did not promote the growth of breast cancer cells or stimulate uterine growth in preclinical studies and, in a phase II trial, was demonstrated to be safe and more effective in reducing the frequency and severity of hot flashes in postmenopausal women compared with placebo. To confirm the safety and efficacy of MF-101, larger phase III trials were planned for 2009. Although MF-101 appears to be a promising therapeutic, the herbal composition of the drug may be a disadvantage, because of the increased risk of causing allergic reactions in the general population. Studies with the MF-101-isolated active compounds liquiritigen and chalcone demonstrated selectivity for ERbeta, with no induction of proliferative events. If these isolates were demonstrated to be as effective and safe in clinical trials as preliminary data suggest regarding MF-101, these compounds could change the way clinicians treat menopause-associated symptoms.

Tropical Malaysians and temperate Koreans exhibit significant differences in sweating sensitivity in response to iontophoretically administered acetylcholine

Natives of the tropics are able to tolerate high ambient temperatures. This results from their long-term residence in hot and often humid tropical climates. This study was designed to compare the peripheral mechanisms of thermal sweating in tropical natives with that of their temperate counterparts. Fifty-five healthy male subjects including 20 native Koreans who live in the temperate Korean climate (Temperate-N) and 35 native tropical Malaysian men that have lived all of their lives in Malaysia (Tropical-N) were enrolled in this study after providing written informed consent to participate. Quantitative sudomotor axon reflex testing after iontophoresis (2 mA for 5 min) with 10% acetylcholine (ACh) was used to determine directly activated (DIR) and axon reflex-mediated (AXR) sweating during ACh iontophoresis. The sweat rate, activated sweat gland density, sweat gland output per single gland activated, and oral and skin temperature changes were measured. The sweat onset time of AXR (nicotinic-receptor-mediated) was 56 s shorter in the Temperate-N than in the Tropical-N subjects (P < 0.0001). The nicotinic-receptor-mediated sweating activity AXR (1), and the muscarinic-receptor-mediated sweating activity DIR, in terms of sweat volume, were 103% and 59% higher in the Temperate-N compared to the Tropical-N subjects (P < 0.0001). The Temperate-N group also had a 17.8% (P < 0.0001) higher active sweat gland density, 35.4% higher sweat output per gland, 0.24 degrees C higher resting oral temperature, and 0.62 degrees C higher resting forearm skin temperature compared to the Tropical-N subjects (P < 0.01). ACh iontophoresis did not influence oral temperature, but increased skin temperature near where the ACh was administered, in both groups. These results suggest that suppressed thermal sweating in the Tropical-N subjects was, at least in part, due to suppressed sweat gland sensitivity to ACh through both recruitment of active sweat glands and the sweat gland output per each gland. This physiological trait guarantees a more economical use of body fluids, thus ensuring more efficient protection against heat stress.

[Clinical study of patients with benzodiazepine dependence, hospitalised between 2006-2008]

The authors present the result of retroprospective clinical diagnosis on benzodiazepines dependence hospitalised in the Drug-Dependence Clinic from the Clinical Hospital of Psychiatry "Socola" Iaşi between January 2006-September 2008.

MATERIAL AND METHOD

The study included a number of 49 patients.

RESULTS

The present article consists of data covering current issues in the area of benzodiazepine side effects. The most frequent clinical manifestations were depression (62.5%), anxiety (52%), perspiration (43%), insomnia (31%), cognitive symptoms (25.2%).

Significant correction of disease after postnatal administration of recombinant ectodysplasin A in canine X-linked ectodermal dysplasia

Patients with defective ectodysplasin A (EDA) are affected by X-linked hypohidrotic ectodermal dysplasia (XLHED), a condition characterized by sparse hair, inability to sweat, decreased lacrimation, frequent pulmonary infections, and missing and malformed teeth. The canine model of XLHED was used to study the developmental impact of EDA on secondary dentition, since dogs have an entirely brachyodont, diphyodont dentition similar to that in humans, as opposed to mice, which have only permanent teeth (monophyodont dentition), some of which are very different (aradicular hypsodont) than brachyodont human teeth. Also, clinical signs in humans and dogs with XLHED are virtually identical, whereas several are missing in the murine equivalent. In our model, the genetically missing EDA was compensated for by postnatal intravenous administration of soluble recombinant EDA. Untreated XLHED dogs have an incomplete set of conically shaped teeth similar to those seen in human patients with XLHED. After treatment with EDA, significant normalization of adult teeth was achieved in four of five XLHED dogs. Moreover, treatment restored normal lacrimation and resistance to eye and airway infections and improved sweating ability. These results not only provide proof of concept for a potential treatment of this orphan disease but also demonstrate an essential role of EDA in the development of secondary dentition.

The safety profiles of orlistat and sibutramine: results of prescription-event monitoring studies in England

INTRODUCTION

Observational cohort studies were conducted using prescription-event monitoring (PEM) to examine the safety profiles of the anti-obesity agents orlistat and sibutramine. Adverse events reported as case reports were also evaluated to determine whether these events were also identified by PEM.

RESEARCH METHODS AND PROCEDURES

Patients were identified from dispensed prescriptions written by general practitioners (GPs) in England for orlistat or sibutramine. Patient demographic and clinical event information, including reasons for stopping and adverse drug reactions, were requested on questionnaires posted to GPs at least 6 months after the first prescription for individual patients. Event incidence densities (IDs) (number of first reports of event/1000 patient-months treatment) were calculated for month 1 (ID(1)) and months 2-3 (ID(2-3)). Published case reports were identified by searching Medline and Embase.

RESULTS

The cohorts comprised 16,021 and 12,336 patients prescribed orlistat and sibutramine, respectively. Both cohorts had a median age of 45 years, and approximately 80% were female. The most common reason for stopping orlistat within 3 months was diarrhea (332 patients; 2.1% cohort), and for stopping sibutramine it was hypertension (203 patients; 1.6%). Clinical events significantly associated with taking orlistat were mainly gastrointestinal and those for sibutramine included central nervous system effects, nausea/vomiting, palpitation, and sweating. We identified 8 published case reports for orlistat and 10 for sibutramine that had equivalent or similar events assessed as causally related in the PEM studies.

CONCLUSIONS

The PEM studies highlighted different adverse event profiles for orlistat and sibutramine that were consistent with their distinct pharmacological mechanisms and other published information.

Phytoestrogens for vasomotor menopausal symptoms

BACKGROUND

Vasomotor symptoms, such as hot flushes and night sweats, are very common during the menopausal transition. Hormone replacement therapy has traditionally been used as a very effective treatment but concerns over increased risks of some chronic diseases have markedly increased the interest of women in alternatives. Some of the most popular of these are treatments based on foods or supplements enriched with phytoestrogens, plant-derived chemicals that have oestrogenic action.

OBJECTIVES

To assess the efficacy, safety and acceptability of foods and supplements based on high levels of phytoestrogens for reducing hot flushes and night sweats in postmenopausal women.

SEARCH STRATEGY

Searches were undertaken of the following electronic databases: the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of randomised trials, Cochrane Register of Controlled Trials (CENTRAL) (March 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007), AMED (1985 to March 2007), PsycINFO (1986 to March 2007) and CINAHL (1982 to March 2007). Attempts were made to access grey literature by letters to pharmaceutical companies and searches of ongoing trial registers. Reference lists of included trials were also searched.

SELECTION CRITERIA

Studies were included if they were randomised, had peri- or postmenopausal participants with vasomotor symptoms, a duration of at least 12 weeks and where the intervention was a food or supplement with high levels of phytoestrogens (and not combined with other herbal treatments). Trials of women who had breast cancer or a history of breast cancer were excluded.

DATA COLLECTION AND ANALYSIS

Selection of trials, data extraction and quality assessment were undertaken by at least two authors. Most of the trials were too dissimilar to combine in meta-analysis and their results are provided in table format. Studies were grouped into broad categories: dietary soy, soy extracts, red clover extracts and other types of phytoestrogen. Five trials used Promensil, a red clover extract; these trials were combined in a meta-analysis and summary effect measures were calculated.

MAIN RESULTS

Thirty trials comparing phytoestrogens with control met the inclusion criteria. Very few trials had data suitable for combining in meta-analysis. Of the five trials with data suitable for pooling that assessed daily frequency of hot flushes, there was no significant difference overall in the frequency of hot flushes between Promensil (a red clover extract) and placebo (WMD=-0.6, 95% CI -1.8 to 0.6). There was no evidence of a difference in percentage reduction in hot flushes in two trials between Promensil and placebo (WMD=20.2, 95% CI -12.1 to 52.4). Individual results from the remaining trials were compared. Some of the trials found that phytoestrogen treatments alleviated the frequency and severity of hot flushes and night sweats when compared to placebo but many of the trials were of low quality and were underpowered. There was a strong placebo effect in most trials with a reduction in frequency ranging from 1% to 59% with placebo. There was no indication that the discrepant results were due to the amount of isoflavone in the active treatment arm, the severity of vasomotor symptoms or trial quality factors. There was also no evidence that the treatments caused oestrogenic stimulation of the endometrium (an adverse effect) when used for up to two years.

AUTHORS' CONCLUSIONS

There is no evidence of effectiveness in the alleviation of menopausal symptoms with the use of phytoestrogen treatments.

A preliminary study of the short circuit current (Isc) responses of sweat gland cells from normal and anhidrotic horses to purinergic and adrenergic agonists

The causal factors of equine anhidrosis have not yet been elucidated but defective electrolyte transport mechanisms in the gland are likely to be involved. To investigate this possibility, experiments were performed on cultured equine sweat gland epithelia from five free-sweating UK horses (3 intact males, 2 mares, aged 2-4 years) and from three free-sweating Singapore horses (1 intact male, 2 mares, aged 3-5 years) and three anhidrotic (Singapore) horses (1 intact male, 1 gelding, 1 mare, aged 3-6 years). Cultured cells from each animal were grown on permeable supports and loaded into Ussing chambers to quantify transepithelial resistance and agonist-induced electrolyte transport by the short circuit current (Isc) technique. Transepithelial resistances across the layers of cultured cells were not significantly different between cells from UK and Singapore free-sweating horses, but were significantly reduced in anhidrotic animals. Purinergic agonists added to the apical and basolateral aspects of the cultured cells caused similar increases in Isc between the two populations of unaffected cells, but Isc increases were significantly reduced in anhidrotic animals. Beta-adrenergic agonist stimulation of the anhidrotic cell layers failed to elicit any change in Isc. These pilot results not only confirm earlier conclusions from anatomical findings that failure in the secretory process occurs in anhidrosis but also indicate that both of the known ion transport mechanisms are involved. The trigger for these failures warrants further investigation.

A static handgrip method for distal quantitative sweat measurements

The quantitative sudomotor axon reflex test (QSART) measures sympathetic C fibre function when iontophoresed acetylcholine (Ach) evokes a measurable reliable sweat response. This study tests a novel, simplified method of sweat stimulation which accompanies hand dynamometry. In 34 healthy subjects we compared the standard sudomotor axon reflex test with a simplified method using static handgrip as sweat stimulus and recorded from the distal forearm, thumb and little finger tips. The standard method failed on technical grounds beyond the forearm. At the distal forearm, sweat rates were 313+/-140nl/min, representing a four-fold increase from baseline. Static handgrip induced sweat rates of 339+/-156 (thumb) and 296+/-139 (little finger)nl/min, representing a 1.7 and 1.6 fold increase from baseline. Static handgrip did not significantly alter distal forearm sweat secretion, and in females handgrip induced significantly less sweating over the thumb than in males. After dynamometry or Ach stimulation, over the three sites (thumb, little finger and forearm), the stimulated sweat secretion volumes were measured at 0.0278+/-0.021microl/cm(2)/min (thumb), 0.0204+/-0.020microl/cm(2)/min (little finger), and 0.0503+/-0.0283microl/cm(2)/min (forearm) after correction. Our study suggests the static handgrip method can be used to stimulate distal sweat production and may be of particular significance in investigating length-dependant neuropathies and assessing distal C fiber function.

Psychotropic drugs use and risk of heat-related hospitalisation

Objective

To assess if use of psychotropic drugs is associated with an increased risk of admission for heat-related pathologies during a heat wave period.

Method

We conducted a matched case–control study. Cases were defined as subjects admitted to an emergency department for heat-related pathology (hyperthermia or heat stroke) over the August 2003 heat wave. Controls were defined as subjects living in the same area but not hospitalised over the same period and who had at least one prescription form submitted for refunding by the social security insurance in July 2003. Multivariate analyses were used to identify psychotropic drugs independently associated with hospital referral during the heat wave period.

Results

Out of the 1405 patients admitted to the emergency department, 56 (4%) presented with heat-related pathology. The mean age of cases was 83 years. Multivariate analyses showed that cases were more likely than controls to be treated with anticholinergic drugs (OR 6.0, 95% CI 1.8–19.6), antipsychotics (OR 4.6, 95% CI 1.9–11.2) or anxiolytics (OR 2.4, 95% CI 1.3–4.4).

Conclusion

In special risk situations such as heat waves, the risk/benefit ratio of psychotropic drugs which could interfere with body temperature regulation has to be carefully assessed, particularly in the elderly.

[Pharmacodynamics research of Guizhi decoction in modern times]

To discuss the present general situation of the pharmacodynamics research of Guizhi decoction. Look up the literature about the research of pharmacodynamics experiments of Guizhi decoction in recent years, then to analyze and coordinate the useful information. Guizhi decoction has the bilateral accommodation for testing animals'suboriferous, body temperature, blood pressure, peristalsis and immune function. And it has the pharmacodynamics effect in resisting bacteria, virus, pain and allergy, reducing the blood sugar, increasing the cardiac muscle blood flux, improving the digestion and transmition of stomach and intestines, and easing up spasmus. It can also prevent the arthritis, and cure the cervical spondylosis and chronic pancreatitis.

Pilocarpine treatment in a mixed cohort of xerostomic patients

OBJECTIVE

To compare the effect of a single 5-mg dose of pilocarpine hydrochloride on the salivary flow rate in three groups of xerostomic patients.

SUBJECTS AND METHODS

Forty-five patients were divided into three groups according to the etiology of their xerostomia: (i) radiotherapy; (ii) Sjögren's syndrome; and (iii) sialosis and xerogenic medications. Following the oral administration of a 5-mg pilocarpine hydrochloride tablet blood pressure, heart rate, body temperature and saliva secretion rates were monitored hourly for 3 h and adverse events were reported.

RESULTS

The most significant and persistent elevation of salivary flow rate was observed in the sialosis/drug-induced group followed by the Sjögren's syndrome group. The radiotherapy group presented a significant elevation of salivary secretion rate after 1 and 2 h, but returned to baseline at 3 h. No significant changes in vital signs were reported, except for low diastolic pressure measured at 1 h in the radiotherapy group. Several adverse events were recorded throughout the trial; however, only one patient withdrew from the study.

CONCLUSION

Treatment with pilocarpine hydrochloride tablets may improve saliva secretion in patients taking xerogenic medications and/or suffering from metabolic sialosis expanding the beneficial potential of this sialogogue.

Durchführung und Interpretation des Schweißtests in deutschen Mukoviszidoseambulanzen

BACKGROUND

Surveys in USA and UK have shown inconsistencies between practice of sweat testing and guidelines of the National Committee for Clinical Laboratory Standards (NCCLS), which could increase the risk of false-positive and -negative results. To determine the current practice of sweat testing in German cystic fibrosis (CF)-centres a survey was performed.

METHOD

A questionnaire was mailed to all 123 German CF-centres that join the German CF-register. The results were compared with the NCCLS-guidelines.

RESULTS

88 out of 113 responding centres perform 30-1100 (median 200) sweat tests by pilocarpine iontophoresis per year. The recommended sweat sample time of 20-30 min was accepted by 33% of all centres. Minimum acceptable sweat rates were quoted between 100 and 7500 (median 1000) mg/m (2)/min differing from the recommended 1000 mg/m (2)/min. Osmolality was measured in 3%, sodium in 24% and conductivity in 53% of the centres. Chloride, the only accepted diagnostic measurement by the NCCLS, was investigated by only 58% of all centres. The recommended chloride CF-reference value of >60 mmol/l was used in 78% of centres that perform chloride testing.

CONCLUSIONS

Major areas of inconsistencies between sweat testing practice in German CF-centres and NCCLS-guidelines are sweat collection, analyzing method and reference values. Chloride, the only accepted diagnostic measurement by the NCCLS, was investigated only by 58% of all centres.

A comparison of medication side effect reports by panic disorder patients with and without concomitant cognitive behavior therapy

OBJECTIVE

The authors assessed whether adding cognitive behavior therapy (CBT) to imipramine for patients with panic disorder decreased the severity of side effects and dropouts from side effects.

METHOD

Data were analyzed for 172 panic disorder patients who were randomly assigned to receive imipramine alone, imipramine plus CBT, or placebo. Mixed-effects models were used to assess longitudinal differences among the treatment groups with respect to side effect burden and dropout rates during the acute, maintenance, and follow-up phases of treatment.

RESULTS

Patients treated with imipramine plus CBT experienced less severe fatigue/weakness, dry mouth, and sweating and had a lower rate of dropout due to side effects compared with those treated with imipramine only.

CONCLUSIONS

The addition of CBT to medication treatment with imipramine was associated with less severe side effects and fewer dropouts due to perceived side effects than treatment with imipramine alone.

Cutaneous blood flow and sweat rate responses to exogenous administration of acetylcholine and methacholine

The aim of this study was to evaluate cutaneous vasodilation and sweating responses to exogenous administration of acetylcholine (ACh) and methacholine (MCh), which have different sensitivities to endogenous cholinesterase. Four intradermal microdialysis probes were placed in dorsal forearm skin: two sites were perfused with ACh (1 x 10(-7)-1 M) and the other two with the same molar concentrations of MCh. Sweat rate (SR) and cutaneous blood flow were simultaneously assessed directly over each microdialysis membrane. Dose-response curves were constructed, and the effective concentration of the drug resulting in 50% of the maximal response (EC(50)) was identified. For SR and cutaneous vascular conductance (CVC), there were no significant differences in EC(50) between sites receiving the same drug: -1.52 +/- 0.18 and -1.19 +/- 0.09 log-molar concentration of ACh at distal and proximal sites, respectively, and -2.35 +/- 0.24 and -2.42 +/- 0.23 log-molar concentration of MCh at distal and proximal sites, respectively, for SR (P > 0.05) and -3.87 +/- 0.32 and -3.97 +/- 0.27 log-molar concentration of ACh at distal and proximal sites, respectively, and -4.78 +/- 0.17 and -4.46 +/- 0.16 log-molar concentration of MCh at distal and proximal sites, respectively, for CVC (P > 0.05). However, the EC(50) for CVC and SR was significantly lower at the MCh than at the ACh sites. A second procedure was performed to confirm that differences in responses between ACh and MCh could be attributed to different cholinesterase sensitivities. Similarly, four microdialysis membranes were placed in dorsal forearm skin: two sites were perfused with ACh and other two with MCh. However, one of each of the ACh and MCh sites was also perfused with 10 microM neostigmine (an acetylcholinesterase inhibitor). Neostigmine at the ACh site induced a leftward shift (i.e., lower EC(50)) of the SR and CVC dose-response curves compared with the site treated with ACh alone, resulting in no difference in the EC(50) for SR and CVC between the ACh + neostigmine and the MCh site. These results suggest that elevations in SR and CVC occur earlier with MCh than with ACh treatment because of differences in cholinesterase susceptibility between these drugs.

Hot Flashes

CASE STUDY

Mr. J is a 68-year-old African American man with a history of advanced prostate cancer. He was diagnosed nine months prior with adenocarcinoma of the prostate, with a Gleason score of 9 and tumor, node, metastasis staging of T3 NO M1. His prostate-specific antigen (PSA) was 483 ng/ml at the time of diagnosis. He immediately began treatment with total androgen blockade after the staging workup was completed.

European pain management discussion forum

Queries from European physicians about analgesic pharmacotherapy and responses from the author are presented. The topics addressed are the characterization and management of rebound headache which was recently reclassified by the International Headache Society as medication overuse headache, the relationship between migraine headaches and risk for stroke, and opioid-induced sweating.

A Double-Blind, Randomized, Comparative Study of Two Type A Botulinum Toxins in the Treatment of Primary Axillary Hyperhidrosis

BACKGROUND

Botulinum toxin (BTX) is an effective treatment for primary axillary hyperhidrosis. In this study we used two toxins not bioequivalent: BOTOX (Allergan, Inc.) and Dysport (Beaufour Ipsen Biotech).

OBJECTIVE

The objective was to compare the efficacy, safety, and tolerability of BOTOX and Dysport in the treatment of primary axillary hyperhidrosis using a conversion factor of 1:3, respectively.

METHODS

In a double-blind, randomized prospective study, 10 patients with primary axillary hyperhidrosis and sweat production exceeding 50 mg/minute received 50 U of BOTOX in one axilla and 150 U of Dysport in the other. We performed Minor's test and gravimetry at 0 days, at 15 days, and monthly for 1 year.

RESULTS

No significant difference was observed in the sweating quantity at baseline. After 1 month all patients had achieved success for both axillae. The sweat rate was reduced by a mean of 97.7% for BOTOX and 99.4% for Dysport, without statistical difference. The duration of benefits was similar between both toxins, with a mean of 260 days for BOTOX and 290 days for Dysport, without statistical difference. The longest symptom-free interval was 12 months (5 patients, 55.6%).

CONCLUSIONS

BOTOX and Dysport presented similar levels of safety and efficacy in the treatment of primary axillary hyperhidrosis when a conversion factor of 1:3 was used.

Training or EPT in perimenopause on balance and flushes

With advancing age, the postural balance function deteriorates as a consequence of decreased functional capacity. Deteriorating balance is a risk factor for bone fractures due to increased risks of falls. It has been suggested that the loss of estrogen, which occurs in relation to the menopause, may be associated with loss of balance. Regular physical exercise without balance training has, in some studies, been shown to have positive effects on the postural balance. The aim of the present study was to examine balance function during the perimenopausal period, and evaluate the effect of estrogen plus progesterone therapy (EPT) or aerobic training on balance. Sixty perimenopausal women were recruited to the study. The subjects were then randomised to either physical training (n=20), EPT (n=20), or to a control group (n=20). The study period was 18 months. Postural stability was measured every third month using a custom-made force platform. The women using EPT achieved better results in 3 of 6 parameters, after 18 months.

Enzyme replacement therapy with agalsidase alfa in children with Fabry disease

AIM

To assess the effects of enzyme replacement therapy (ERT) in children with Fabry disease.

METHODS

Safety and efficacy of ERT with agalsidase alfa, 0.2 mg/kg infused over 40 minutes every 2 weeks for 23 weeks, were studied in a multicentre open-label trial in nine boys and four girls. Median age at the start of the study was 11.0 years (range 3.5-18 years).

RESULTS

Fifty-four adverse events were reported in 11 patients. No serious adverse events related to ERT were reported. Twelve of the 54 adverse events were considered possibly or probably related to ERT. Infusion reactions (8 mild, 3 moderate) occurred in four boys, in seven infusions. One boy developed IgG antibodies, although he continued to make good clinical progress. At the end of the study, two of the four boys and the one girl on regular pain medication at baseline had stopped taking analgesics. Brief Pain Inventory (BPI) scores decreased in most patients by week 12 and were sustained until the end of the study. This change was greater in the boys, who had higher (worse) BPI scores at baseline. Pain-related quality of life (QoL) scores also decreased during the study. Plasma globotriaosylceramide concentrations and urinary globotriaosylceramide:sphingomyelin ratios decreased after 12 and 23 weeks of therapy, particularly in the boys. Increases in sweat volume were recorded in three out of five of the boys and in one of two girls tested after 23 weeks of treatment.

CONCLUSION

ERT with agalsidase alfa in children with Fabry disease is well tolerated and, in the short term, appears to decrease pain and to improve pain-related QoL.