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Leonart LP, Fachi MM, Böger B, Silva MRD, Szpak R, Lombardi NF, Pedroso MLA, Pontarolo R. A Systematic Review and Meta-analyses of Longitudinal Studies on Drug Treatments for Gaucher Disease. Ann Pharmacother 2023; 57:267-282. [PMID: 35815393 DOI: 10.1177/10600280221108443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Gaucher disease (GD) is a rare disorder linked to the absence/deficiency of glucocerebrosidase. GD can be treated by enzyme replacement therapy (ERT) and substrate reduction therapy (SRT). The aim of this systematic review (SR) is to assess the effectiveness of drugs used for GD treatment. DATA SOURCES Searches were conducted in PubMed and Scopus, in April 2021. The search strategies encompassed the name of the disease and of the drug treatments. Manual search was also conducted. STUDY SELECTION AND DATA EXTRACTION Observational and interventional longitudinal studies evaluating ERT and SRT for GD were included. Single mean meta-analyses were conducted for each drug using R. DATA SYNTHESIS The initial search retrieved 2246 articles after duplicates were removed. Following screening and eligibility assessment, 68 reports were included. The studies evaluated imiglucerase, velaglucerase alfa, taliglucerase alfa, miglustat, and eliglustat. The results showed that ERT is effective as a treatment in both naïve and experienced patients. Miglustat did not significantly improve blood outcomes in naïve patients and resulted in a decrease in the platelet levels of experienced patients. Eliglustat was mainly assessed for experienced patients and resulted in stable outcome values. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This extensive SR confirms the effectiveness of GD treatments in short- and long-term follow-ups. CONCLUSIONS The results were favorable for all ERTs and for eliglustat. Based on the assessed evidence, miglustat did not achieved expressive results. However, all evidence should be interpreted considering its limitations and does not replace well-conducted randomized trials.
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Affiliation(s)
- Letícia Paula Leonart
- Graduate Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba, Brazil
| | - Mariana M Fachi
- Graduate Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba, Brazil
| | - Beatriz Böger
- Graduate Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba, Brazil
| | | | - Renata Szpak
- Graduate Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba, Brazil
| | | | | | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil
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2
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Hemostatic Abnormalities in Gaucher Disease: Mechanisms and Clinical Implications. J Clin Med 2022; 11:jcm11236920. [PMID: 36498496 PMCID: PMC9735904 DOI: 10.3390/jcm11236920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Gaucher disease (GD) is a rare inherited lysosomal metabolism disorder, characterized by an accumulation into lysosomes of reticuloendothelial cells, especially in the bone marrow, spleen, and liver of β-glucosylceramide and glucosyl sphingosine, which is its deacylated product. Impaired storage is responsible for a chronic inflammatory state at the sites of accumulation and together represents the pathophysiological cause of GD. GD is a progressive, multi-organ chronic disorder. Type 1 GD is the most prevalent form, with heterogeneous multisystem involvement and different severity of symptoms at any age. Hematological involvement is consistent, and a bleeding tendency is frequent, particularly at diagnosis. Several coagulation and primary hemostasis abnormalities are observed in GD. Bleeding manifestations are rarely severe and usually mucocutaneous. Post-operative, delivery, and post-partum hemorrhages are also common. Thrombocytopenia, platelet function defects, and clotting abnormalities, alone or variably associated, contribute to increase the risk of bleeding in GD. Enzyme replacement therapy (ERT) or substrate reduction therapy (SRT) are the two specific available treatments effective in improving typical hematological symptoms and abnormalities, including those of hemostasis. However, the use of medication to potentiate hemostasis may be also useful in defined clinical situations: recent starting of ERT/SRT, surgery, delivery, and life-threatening bleeding.
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Canales-Siguero D, García-Muñoz C, Quijada Fraile P, Morales Conejo M, Ferrari-Piquero JM, Martín-Hernández E. Efectividad y seguridad del tratamiento de las enfermedades de depósito lisosomal: análisis de 22 pacientes. Med Clin (Barc) 2022; 159:380-384. [DOI: 10.1016/j.medcli.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
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Weinreb NJ, Goker-Alpan O, Kishnani PS, Longo N, Burrow TA, Bernat JA, Gupta P, Henderson N, Pedro H, Prada CE, Vats D, Pathak RR, Wright E, Ficicioglu C. The diagnosis and management of Gaucher disease in pediatric patients: Where do we go from here? Mol Genet Metab 2022; 136:4-21. [PMID: 35367141 DOI: 10.1016/j.ymgme.2022.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
Gaucher disease (GD) is an autosomal recessive inherited lysosomal storage disease that often presents in early childhood and is associated with damage to multiple organ systems. Many challenges associated with GD diagnosis and management arise from the considerable heterogeneity of disease presentations and natural history. Phenotypic classification has traditionally been based on the absence (in type 1 GD) or presence (in types 2 and 3 GD) of neurological involvement of varying severity. However, patient management and prediction of prognosis may be best served by a dynamic, evolving definition of individual phenotype rather than by a rigid system of classification. Patients may experience considerable delays in diagnosis, which can potentially be reduced by effective screening programs; however, program implementation can involve ethical and practical challenges. Variation in the clinical course of GD and an uncertain prognosis also complicate decisions concerning treatment initiation, with differing stakeholder perspectives around efficacy and acceptable cost/benefit ratio. We review the challenges faced by physicians in the diagnosis and management of GD in pediatric patients. We also consider future directions and goals, including acceleration of accurate diagnosis, improvements in the understanding of disease heterogeneity (natural history, response to treatment, and prognosis), the need for new treatments to address unmet needs for all forms of GD, and refinement of the tools for monitoring disease progression and treatment efficacy, such as specific biomarkers.
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Affiliation(s)
- Neal J Weinreb
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ozlem Goker-Alpan
- Lysosomal and Rare Disorders Research and Treatment Center, Fairfax, VA, USA.
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - Nicola Longo
- Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA.
| | - T Andrew Burrow
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
| | - John A Bernat
- Division of Medical Genetics and Genomics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
| | - Punita Gupta
- St Joseph's University Hospital, Paterson, NJ, USA.
| | - Nadene Henderson
- Division of Genetic and Genomic Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Helio Pedro
- Center for Genetic and Genomic Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Carlos E Prada
- Division of Genetics, Birth Defects & Metabolism, Ann & Robert H. Lurie Children's Hospital and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Divya Vats
- Kaiser Permanente Southern California, Los Angeles, CA, USA.
| | - Ravi R Pathak
- Takeda Pharmaceuticals USA, Inc., Lexington, MA, USA.
| | | | - Can Ficicioglu
- Division of Human Genetics and Metabolism, The Children's Hospital of Philadelphia, Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, PA, USA.
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5
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Kishnani PS, Al-Hertani W, Balwani M, Göker-Alpan Ö, Lau HA, Wasserstein M, Weinreb NJ, Grabowski G. Screening, patient identification, evaluation, and treatment in patients with Gaucher disease: Results from a Delphi consensus. Mol Genet Metab 2022; 135:154-162. [PMID: 34972655 DOI: 10.1016/j.ymgme.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Several guidelines are available for identification and management of patients with Gaucher disease, but the most recent guideline was published in 2013. Since then, there have been significant advances in newborn screening, phenotypic characterization, identification of biomarkers and their integration into clinical practice, and the development and approval of new treatment options. Accordingly, the goal of this Delphi consensus exercise was to extend prior initiatives of this type by addressing issues related to newborn screening, diagnostic evaluations, and treatment (both disease directed and adjunctive). The iterative Delphi process involved creation of an initial slate of statements, review by a steering committee, and three rounds of consensus development by an independent panel. A preliminary set of statements was developed by the supporting agency based on literature searches covering the period from 1965 to 2020. The Delphi process reduced an initial set of 185 statements to 65 for which there was unanimous support from the panel. The statements supported may ultimately provide a framework for more detailed treatment guidelines. In addition, the statements for which unanimous support could not be achieved help to identify evidence gaps that are targets for future research.
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Affiliation(s)
- Priya S Kishnani
- Duke University Medical Center, Department of Molecular Genetics and Microbiology, 905 Lasalle Street, GSRB1, 4th Floor, Durham, NC 27710, USA.
| | - Walla Al-Hertani
- Harvard Medical School, Boston Children's Hospital, Department of Pediatrics, Division of Genetics and Genomics, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Manisha Balwani
- Icahn School of Medicine at Mount Sinai, Division of Medical Genetics and Genomics, Department of Genetics and Genomic Sciences, 1428 Madison Avenue, 1st Floor, New York, NY 10029, USA
| | - Özlem Göker-Alpan
- Lysosomal & Rare Disorders Research & Treatment Center, 3702 Pender Drive, Suite 170, Fairfax, VA 22030, USA
| | - Heather A Lau
- Ultragenyx Pharmaceutical Inc., Global Clinical Development, 840 Memorial Drive, Cambridge, MA 02139, USA
| | - Melissa Wasserstein
- The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Division of Pediatric Genetic Medicine, Departments of Pediatrics and Genetics, 3411 Wayne Ave, 9th Floor, Bronx, NY 10467, USA
| | - Neal J Weinreb
- University of Miami Miller School of Medicine, Departments of Human Genetics and Medicine, Hematology Division, 7367 Wexford Terrace, Boca Raton, FL 33433, USA
| | - Gregory Grabowski
- University of Cincinnati College of Medicine, Department of Pediatrics, and Department of Molecular Genetics, Biochemistry and Microbiology, Division of Human Genetics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH, USA
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Sagara R, Ishigaki M, Otsuka M, Murayama K, Ida H, Fernandez J. Long-term safety and effectiveness of velaglucerase alfa in Gaucher disease: 6-year interim analysis of a post-marketing surveillance in Japan. Orphanet J Rare Dis 2021; 16:502. [PMID: 34863216 PMCID: PMC8642863 DOI: 10.1186/s13023-021-02119-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gaucher disease (GD) is caused by reduced lysosomal enzyme β-glucocerebrosidase activity. Heterogeneous genotypes and phenotypes have been observed within GD types and across ethnicities. Enzyme replacement therapy is generally recommended for patients with type 1 GD, the least severe form of GD. In Japan, velaglucerase alfa has a broad indication covering type 1, 2 or 3 GD. METHODS: All patients with type 1, 2, or 3 GD administered velaglucerase alfa 60 U/kg every 2 weeks via intravenous infusion after its launch date in Japan in 2014, were enrolled in a non-interventional, observational post-marketing surveillance (PMS). Individual patient data were reported via case report forms (CRFs). Key safety endpoints investigated included the incidence of infusion-related reactions (IRRs), the safety of velaglucerase alfa in patients with types 2 and 3 GD, from patients under one year of age to elderly patients (≥ 65 years of age). Long-term efficacy was also assessed. RESULTS: In total, 53 patients with GD were registered. CRFs were available for 41 (77.4%) patients at the 6-year interim analysis. Fourteen adverse drug reactions (ADRs) were reported in seven patients. All reported ADRs occurred in patients with type 2 GD. ADRs were reported by 63.6% (7/11) of patients with type 2 GD. Ten ADRs were reported in five patients aged < 4 years. No elderly patients experienced any ADR during the surveillance period. Five ADRs occurring in three (10.0%) patients were classified as IRRs, with one case of vomiting (moderate severity) resulting in treatment discontinuation. Ten serious adverse events were reported in five (16.7%) patients. Three fatal events were considered to be unrelated to treatment with velaglucerase alfa. Platelet counts increased after the administration of velaglucerase alfa and were generally maintained within the normal range over the administration period. Among eleven patients tested for neutralizing anti-velaglucerase alfa antibodies, two (18.2%) were assessed as positive results. CONCLUSION: PMS data from patients with types 1-3 GD in Japan indicate that long-term treatment with velaglucerase alfa was well-tolerated and associated with increased platelet counts, which is consistent with observations made in studies outside of Japan. TRIAL REGISTRATION NCT03625882 registered July 2014.
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Affiliation(s)
- Rieko Sagara
- Japan Medical Office, Takeda Pharmaceutical Company Limited, 2-1-1, Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8668, Japan.
| | - Masahide Ishigaki
- Japan Medical Office, Takeda Pharmaceutical Company Limited, 2-1-1, Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8668, Japan
| | - Manami Otsuka
- Japan Medical Office, Takeda Pharmaceutical Company Limited, 2-1-1, Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8668, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, 579-1, Heta-cho Midori-ku, Chiba, 266-0007, Japan
| | - Hiroyuki Ida
- The Jikei University Hospital, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, 2-1-1, Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8668, Japan
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7
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Dinur T, Grittner U, Revel-Vilk S, Becker-Cohen M, Istaiti M, Cozma C, Rolfs A, Zimran A. Impact of Long-Term Enzyme Replacement Therapy on Glucosylsphingosine (Lyso-Gb1) Values in Patients with Type 1 Gaucher Disease: Statistical Models for Comparing Three Enzymatic Formulations. Int J Mol Sci 2021; 22:ijms22147699. [PMID: 34299318 PMCID: PMC8307068 DOI: 10.3390/ijms22147699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 01/14/2023] Open
Abstract
For three decades, enzyme replacement therapy (ERT), and more recently, substrate reduction therapy, have been the standard-of-care for type I Gaucher disease (GD1). Since 2012, three different ERTs have been available. No clinical trial or academic study has ever compared these ERTs beyond one year. Herein we compare the impact of the ERTs on repeated measurements of glucosylsphingosine (lyso-Gb1; the most sensitive and GD-specific biomarker). A total of 135 adult patients (77 (57%) female) with GD1, followed from July 2014 to March 2020 and treated with a single ERT (imiglucerase (n = 41, 30.4%), taliglucerase alfa (n = 21, 15.6%) and velaglucerase alfa (n = 73, 54.1%)), were included. Disease severity was defined by genotypes (mild: N370S (c.1226A>G) homozygous and N370S/R496H (c.1604G) compound heterozygous; severe: all other genotypes) and by the severity score index (SSI; mild: <7; severe: ≥7). Lyso-Gb1 testing was performed at Centogene™ on dry blood spot samples collected during routine visits. Patients treated with imiglucerase had higher lyso-Gb1 levels at different time points. A huge variation in lyso-Gb1 levels was noticeable both inter-individually and intra-individually for all three ERTs. A steeper and faster decrease of lyso-Gb1 levels was shown in velaglucerase alfa. Nevertheless, the differences between medications were not very large, and bigger numbers and more pretreatment data are required for more powerful conclusions.
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Affiliation(s)
- Tama Dinur
- Shaare Zedek Medical Center, Gaucher Unit, Jerusalem 9103102, Israel; (T.D.); (M.B.-C.); (M.I.); (A.Z.)
| | - Ulrike Grittner
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Centogene AG, 18055 Rostock, Germany;
| | - Shoshana Revel-Vilk
- Shaare Zedek Medical Center, Gaucher Unit, Jerusalem 9103102, Israel; (T.D.); (M.B.-C.); (M.I.); (A.Z.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel
- Correspondence: ; Tel.: +972-2-655-5673; Fax: +972-2-651-7979
| | - Michal Becker-Cohen
- Shaare Zedek Medical Center, Gaucher Unit, Jerusalem 9103102, Israel; (T.D.); (M.B.-C.); (M.I.); (A.Z.)
| | - Majdolen Istaiti
- Shaare Zedek Medical Center, Gaucher Unit, Jerusalem 9103102, Israel; (T.D.); (M.B.-C.); (M.I.); (A.Z.)
| | | | - Arndt Rolfs
- Medical Faculty, University of Rostock, 18051 Rostock, Germany;
| | - Ari Zimran
- Shaare Zedek Medical Center, Gaucher Unit, Jerusalem 9103102, Israel; (T.D.); (M.B.-C.); (M.I.); (A.Z.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel
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Borie R, Crestani B, Guyard A, Lidove O. Interstitial lung disease in lysosomal storage disorders. Eur Respir Rev 2021; 30:30/160/200363. [PMID: 33927007 DOI: 10.1183/16000617.0363-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/27/2020] [Indexed: 11/05/2022] Open
Abstract
Lysosomes are intracellular organelles that are responsible for degrading and recycling macromolecules. Lysosomal storage diseases (LSDs) are a group of inherited diseases caused by mutations affecting genes that encode the function of the lysosomal enzymes. Three LSDs are associated with lung involvement and/or interstitial lung disease (ILD): Gaucher disease (GD); Niemann-Pick disease, also known as acid sphingomyelinase deficiency (ASMD); and Fabry disease (FD). In GD and in ASMD, analysis of bronchoalveolar lavage fluid and lung biopsy can be informative, showing foamy cells. In GD, ILD is rare. Enzyme replacement therapy (ERT) has been available since 1991 and has greatly changed the natural history of GD, with pulmonary failure and death reported before the ERT era. In ASMD, ILD is frequent and is usually associated with spleen enlargement, low platelet cell count and low level of high-density lipoprotein-cholesterol. Results of ERT are promising regarding preliminary results of olipudase alfa in paediatric and adult ASMD populations. The most frequent respiratory manifestation in FD is COPD-like symptoms regardless of smoking habit and dyspnoea due to congestive heart failure. Early diagnosis of these three LSDs is crucial to prevent irreversible organ damage. Early initiation of ERT can, at least in part, prevent organ failure.
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Affiliation(s)
- Raphaël Borie
- Service de Pneumologie A, Centre de Référence des maladies pulmonaires rares, DHU APOLLO, APHP, Hôpital Bichat, Paris, France .,Université de Paris, INSERM U1152, Labex INFLAMEX, Paris, France
| | - Bruno Crestani
- Service de Pneumologie A, Centre de Référence des maladies pulmonaires rares, DHU APOLLO, APHP, Hôpital Bichat, Paris, France.,Université de Paris, INSERM U1152, Labex INFLAMEX, Paris, France
| | - Alice Guyard
- Laboratoire d'anatomopathologie, Hôpital Bichat, Paris, France
| | - Olivier Lidove
- Service de Médecine Interne, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.,Centre de Référence Maladies Lysosomales (CRML, site Diaconesses Croix Saint-Simon) - Filière Maladies Rares G2M, Paris, France
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9
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Raskovalova T, Deegan PB, Mistry PK, Pavlova E, Yang R, Zimran A, Berger J, Bourgne C, Pereira B, Labarère J, Berger MG. Accuracy of chitotriosidase activity and CCL18 concentration in assessing type I Gaucher disease severity. A systematic review with meta-analysis of individual participant data. Haematologica 2021; 106:437-445. [PMID: 32001533 PMCID: PMC7849573 DOI: 10.3324/haematol.2019.236083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/20/2020] [Indexed: 12/22/2022] Open
Abstract
Chitotriosidase activity and CCL18 concentration are interchangeably used for monitoring Gaucher disease (GD) activity, together with clinical assessment. However, comparative studies of these two biomarkers are scarce and of limited sample size. The aim of this systematic review with meta-analysis of individual participant data (IPD) was to compare the accuracy of chitotriosidase activity and CCL18 concentration for assessing type I GD severity. We identified cross-sectional and prospective cohort studies by searching Medline, EMBASE, and CENTRAL from 1995 to June 2017, and by contacting research groups. The primary outcome was a composite of liver volume >1.25 multiple of normal (MN), spleen volume >5 MN, hemoglobin concentration <11 g/dL, and platelet count <100x109/L. Overall, IPD included 1109 observations from 334 patients enrolled in nine primary studies, after excluding 111 patients with undocumented values and 18 patients with deficient chitotriosidase activity. IPD were unavailable for 14 eligible primary studies. The primary outcome was associated with a 5.3-fold (95% confidence interval [CI], 4.2 to 6.6) and 3.0-fold (95% CI, 2.6 to 3.6) increase of the geometric mean for chitotriosidase activity and CCL18 concentration, respectively. The corresponding areas under the receiver operating characteristics curves were 0.82 and 0.84 (summary difference, 0.02, 95% CI, -0.02 to 0.05). The addition of chitotriosidase activity did not improve the accuracy of CCL18 concentration. Estimates remained robust in the sensitivity analysis and consistent across subgroups. Neither chitotriosidase activity nor CCL18 concentration varied significantly according to a recent history of bone events among 97 patients. In conclusion, CCL18 concentration is as accurate as chitotriosidase activity in assessing hematological and visceral parameters of GD severity and can be measured in all GD patients. This meta-analysis supports the use of CCL18 rather than chitotriosidase activity for monitoring GD activity in routine practice.
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Affiliation(s)
- Tatiana Raskovalova
- Lab immunologie, Grenoble University Hospital, Universite' Grenoble Alpes, Grenoble, France
| | - Patrick B Deegan
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Pramod K Mistry
- Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, CT, USA
| | - Elena Pavlova
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ruby Yang
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ari Zimran
- Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Juliette Berger
- CHU Clermont-Ferrand, Hopital Estaing, Hematologie Biologique, Clermont-Ferrand, France
| | - Céline Bourgne
- CHU Clermont-Ferrand, Hopital Estaing, Hematologie Biologique, Clermont-Ferrand, France
| | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand Cedex, France
| | - José Labarère
- Univ. Grenoble Alpes, TIMC UMR CNRS 5525, Grenoble University Hospital, Grenoble, France
| | - Marc G Berger
- CHU Clermont-Ferrand, Hopital Estaing, Hematologie Biologique, Clermont-Ferrand, France
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10
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Rowland RJ, Wu L, Liu F, Davies GJ. A baculoviral system for the production of human β-glucocerebrosidase enables atomic resolution analysis. Acta Crystallogr D Struct Biol 2020; 76:565-580. [PMID: 32496218 PMCID: PMC7271948 DOI: 10.1107/s205979832000501x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/09/2020] [Indexed: 11/18/2022] Open
Abstract
The lysosomal glycoside hydrolase β-glucocerebrosidase (GBA; sometimes called GBA1 or GCase) catalyses the hydrolysis of glycosphingolipids. Inherited deficiencies in GBA cause the lysosomal storage disorder Gaucher disease (GD). Consequently, GBA is of considerable medical interest, with continuous advances in the development of inhibitors, chaperones and activity-based probes. The development of new GBA inhibitors requires a source of active protein; however, the majority of structural and mechanistic studies of GBA today rely on clinical enzyme-replacement therapy (ERT) formulations, which are incredibly costly and are often difficult to obtain in adequate supply. Here, the production of active crystallizable GBA in insect cells using a baculovirus expression system is reported, providing a nonclinical source of recombinant GBA with comparable activity and biophysical properties to ERT preparations. Furthermore, a novel crystal form of GBA is described which diffracts to give a 0.98 Å resolution unliganded structure. A structure in complex with the inactivator 2,4-dinitrophenyl-2-deoxy-2-fluoro-β-D-glucopyranoside was also obtained, demonstrating the ability of this GBA formulation to be used in ligand-binding studies. In light of its purity, stability and activity, the GBA production protocol described here should circumvent the need for ERT formulations for structural and biochemical studies and serve to support GD research.
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Affiliation(s)
- Rhianna J. Rowland
- Department of Chemistry, York Structural Biology Laboratory, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Liang Wu
- Department of Chemistry, York Structural Biology Laboratory, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Feng Liu
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Gideon J. Davies
- Department of Chemistry, York Structural Biology Laboratory, University of York, Heslington, York YO10 5DD, United Kingdom
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11
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Liver involvement in patients with Gaucher disease types I and III. Mol Genet Metab Rep 2020; 22:100564. [PMID: 32099816 PMCID: PMC7026612 DOI: 10.1016/j.ymgmr.2019.100564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background & aims Gaucher disease (GD) is a multisystemic disease. Liver involvement in GD is not well characterised and ranges from hepatomegaly to cirrhosis and hepatocellular carcinoma. We aim to describe, and assess the effect of treatment, on the hepatic phenotype of a cohort of patients with GD types I and II. Methods Retrospective study based on the review of the medical files of the Gaucher Reference Centre of the Hospital de Clínicas de Porto Alegre, Brazil. Data from all GD types I and III patients seen at the centre since 2003 were analysed. Variables were compared as pre- (“baseline”) and post-treatment (“follow-up”). Results Forty-two patients (types I: 39, III: 3; female: 22; median age: 35 y; enzyme replacement therapy: 37; substrate reduction therapy: 2; non-treated: 3; median time on treatment-MTT: 124 months) were included. Liver enzyme abnormalities, hepatomegaly, and steatosis at baseline were seen in 19/28 (68%), 28/42 (67%), and 3/38 patients (8%), respectively; at follow-up, 21/38 (55%), 15/38 (39%) and 15/38 (39%). MRI iron quantification showed overload in 7/8 patients (treated: 7; MTT: 55 months), being severe in 2/7 (treated: 2/2; MTT: 44.5 months). Eight patients had liver biopsy (treated: 6; MTT: 58 months), with fibrosis in 3 (treated: 1; time on treatment: 108 months) and steatohepatitis in 2 (treated: 2; time on treatment: 69 and 185 months). One patient developed hepatocellular carcinoma. Conclusions GD is a heterogeneous disease that causes different patterns of liver damage even during treatment. Although treatment improves the hepatocellular damage, it is associated with an increased rate of steatosis. This study highlights the importance of a follow-up of liver integrity in these patients.
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Giraldo P. Current and Emerging Pharmacotherapy for Gaucher Disease. Clin Rev Bone Miner Metab 2019. [DOI: 10.1007/s12018-019-09267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mehta A, Kuter DJ, Salek SS, Belmatoug N, Bembi B, Bright J, vom Dahl S, Deodato F, Di Rocco M, Göker‐Alpan O, Hughes DA, Lukina EA, Machaczka M, Mengel E, Nagral A, Nakamura K, Narita A, Oliveri B, Pastores G, Pérez‐López J, Ramaswami U, Schwartz IV, Szer J, Weinreb NJ, Zimran A. Presenting signs and patient co-variables in Gaucher disease: outcome of the Gaucher Earlier Diagnosis Consensus (GED-C) Delphi initiative. Intern Med J 2019; 49:578-591. [PMID: 30414226 PMCID: PMC6852187 DOI: 10.1111/imj.14156] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gaucher disease (GD) presents with a range of signs and symptoms. Physicians can fail to recognise the early stages of GD owing to a lack of disease awareness, which can lead to significant diagnostic delays and sometimes irreversible but avoidable morbidities. AIM The Gaucher Earlier Diagnosis Consensus (GED-C) initiative aimed to identify signs and co-variables considered most indicative of early type 1 and type 3 GD, to help non-specialists identify 'at-risk' patients who may benefit from diagnostic testing. METHODS An anonymous, three-round Delphi consensus process was deployed among a global panel of 22 specialists in GD (median experience 17.5 years, collectively managing almost 3000 patients). The rounds entailed data gathering, then importance ranking and establishment of consensus, using 5-point Likert scales and scoring thresholds defined a priori. RESULTS For type 1 disease, seven major signs (splenomegaly, thrombocytopenia, bone-related manifestations, anaemia, hyperferritinaemia, hepatomegaly and gammopathy) and two major co-variables (family history of GD and Ashkenazi-Jewish ancestry) were identified. For type 3 disease, nine major signs (splenomegaly, oculomotor disturbances, thrombocytopenia, epilepsy, anaemia, hepatomegaly, bone pain, motor disturbances and kyphosis) and one major co-variable (family history of GD) were identified. Lack of disease awareness, overlooking mild early signs and failure to consider GD as a diagnostic differential were considered major barriers to early diagnosis. CONCLUSION The signs and co-variables identified in the GED-C initiative as potentially indicative of early GD will help to guide non-specialists and raise their index of suspicion in identifying patients potentially suitable for diagnostic testing for GD.
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Affiliation(s)
- Atul Mehta
- Lysosomal Storage Disorders Unit, Department of HaematologyRoyal Free Hospital, UCL Medical SchoolLondonUK
| | - David J. Kuter
- Center for HematologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Sam S. Salek
- School of Life and Medical Sciences, University of HertfordshireHatfieldUK
| | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, University Hospital Paris Nord Val de Seine, site Beaujon, ClichyParisFrance
| | - Bruno Bembi
- Centre for Rare DiseasesAcademic Medical Centre Hospital of UdineUdineItaly
| | - Jeremy Bright
- Research Evaluation UnitOxford PharmaGenesis LtdOxfordUK
| | - Stephan vom Dahl
- Department of Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine UniversityDüsseldorfGermany
| | - Federica Deodato
- Division of Metabolism, Department of Pediatric SpecialistBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of PediatricsIRCCS Giannina Gaslini InstituteGenoaItaly
| | - Ozlem Göker‐Alpan
- Lysosomal Disorders Unit and CFCTO and O Alpan LLCFairfaxVirginiaUSA
| | - Derralynn A. Hughes
- Lysosomal Storage Disorders Unit, Department of HaematologyRoyal Free Hospital, UCL Medical SchoolLondonUK
| | - Elena A. Lukina
- Department of Orphan DiseasesNational Research Center for HematologyMoscowRussia
| | - Maciej Machaczka
- Medical FacultyUniversity of RzeszowRzeszowPoland
- Department of Medicine at HuddingeHematology Center Karolinska, Karolinska Institute, Karolinska University Hospital HuddingeStockholmSweden
| | - Eugen Mengel
- Villa MetabolicaCenter of Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Aabha Nagral
- Department of GastroenterologyJaslok Hospital and Research CentreMumbaiIndia
- Department of GastroenterologyApollo HospitalMumbaiIndia
| | - Kimitoshi Nakamura
- Department of PediatricsGraduate School of Medical Sciences, Kumamoto UniversityKumamotoJapan
| | - Aya Narita
- Department of Child NeurologyFaculty of Medicine, Tottori UniversityYon agoJapan
| | - Beatriz Oliveri
- Osteoporosis and Metabolic Bone Diseases Laboratory, Institute of Immunology, Genetics, and Metabolism (INIGEM) CONICET ‐ UBABuenos AiresArgentina
| | - Gregory Pastores
- University College Dublin, The Mater Misericordiae University HospitalDublinIreland
| | | | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Department of HaematologyRoyal Free Hospital, UCL Medical SchoolLondonUK
| | - Ida V. Schwartz
- Medical Genetics Service – HCPA, Genetics DepartmentUFRGSPorto AlegreBrazil
| | - Jeff Szer
- Department of Clinical Haematology, Bone Marrow Transplant ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Neal J. Weinreb
- Department of Human Genetics and Medicine (Hematology)University of Miami Miller School of Medicine, UHealth Sylvester Coral SpringsCoral SpringsFloridaUSA
| | - Ari Zimran
- Shaare Zedek Medical Center and Hadassah Medical SchoolJerusalemIsrael
- Hadassah Medical SchoolJerusalemIsrael
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Nguyen Y, Stirnemann J, Belmatoug N. La maladie de Gaucher : quand y penser ? Rev Med Interne 2019; 40:313-322. [DOI: 10.1016/j.revmed.2018.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/12/2018] [Accepted: 11/25/2018] [Indexed: 12/23/2022]
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Rodríguez-López A, Pimentel-Vera LN, Espejo-Mojica AJ, Van Hecke A, Tiels P, Tomatsu S, Callewaert N, Alméciga-Díaz CJ. Characterization of Human Recombinant N-Acetylgalactosamine-6-Sulfate Sulfatase Produced in Pichia pastoris as Potential Enzyme for Mucopolysaccharidosis IVA Treatment. J Pharm Sci 2019; 108:2534-2541. [PMID: 30959056 DOI: 10.1016/j.xphs.2019.03.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
Mucopolysaccharidosis IVA (MPS IVA or Morquio A syndrome) is a lysosomal storage disease caused by the deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS), leading to lysosomal storage of keratan sulfate and chondroitin-6-sulfate. Currently, enzyme replacement therapy using an enzyme produced in CHO cells represents the main treatment option for MPS IVA patients. As an alternative, we reported the production of an active GALNS enzyme produced in the yeast Pichia pastoris (prGALNS), which showed internalization by cultured cells through a potential receptor-mediated process and similar post-translational processing as human enzyme. In this study, we further studied the therapeutic potential of prGALNS through the characterization of the N-glycosylation structure, in vitro cell uptake and keratan sulfate reduction, and in vivo biodistribution and generation of anti-prGALNS antibodies. Taken together, these results represent an important step in the development of a P. pastoris-based platform for production of a therapeutic GALNS for MPS IVA enzyme replacement therapy.
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Affiliation(s)
- Alexander Rodríguez-López
- Institute for the Study of Inborn Errors of Metabolism, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia; Chemical Department, School of Science, Pontificia Universidad Javeriana, Bogotá, Colombia; VIB Center for Medical Biotechnology, Ghent, Belgium; Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| | - Luisa N Pimentel-Vera
- Institute for the Study of Inborn Errors of Metabolism, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Angela J Espejo-Mojica
- Institute for the Study of Inborn Errors of Metabolism, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Annelies Van Hecke
- VIB Center for Medical Biotechnology, Ghent, Belgium; Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| | - Petra Tiels
- VIB Center for Medical Biotechnology, Ghent, Belgium; Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| | - Shunji Tomatsu
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Departments of Orthopedics and BioMedical, Skeletal Dysplasia, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803
| | - Nico Callewaert
- VIB Center for Medical Biotechnology, Ghent, Belgium; Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| | - Carlos J Alméciga-Díaz
- Institute for the Study of Inborn Errors of Metabolism, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia.
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Abstract
INTRODUCTION Gaucher disease (GD) is an autosomal recessive disorder resulting from the deficiency of the lysosomal enzyme glucocerebrosidase (b-glucosidase), associated with varying degrees of visceral, bone and central nervous system pathology, leading to wide phenotypic diversity. Response to therapy and clinical outcomes are very different between the three clinical subtypes - non-neuronopathic, acute neuronopathic, and chronic neuronopathic forms; hence a definitive clinical diagnosis is essential. The availability of two therapeutic options, i.e. enzyme replacement and substrate reduction, has transformed the natural course of the disease. As pre-treatment disease severity clearly impacts results of therapy, early diagnosis and initiation of treatment especially in the pediatric population are keys to achieving an optimal outcome. Areas covered: We reviewed the literature concerning the treatment of GD focusing on pediatric presentations, various pharmacological treatment options and recommendations for management goals. A PubMed literature search was performed for relevant publications between 1991 and September 2018. Expert commentary: The approval of enzyme replacement therapy (ERT) for GD in the pediatric age group has significantly altered the course of the disease, especially for non-neuronopathic and chronic neuronopathic forms, as ERT does not cross the blood-brain barrier. Early diagnosis, regular follow-up and early initiation of treatment can thus prevent some irreversible complications and improve patient quality of life.
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Affiliation(s)
- Punita Gupta
- a Division of Genetics, Department of Pediatrics , St. Joseph's Children's Hospital , Paterson , NJ , USA
| | - Gregory Pastores
- b Department of Medicine (Genetics) , University College Dublin , Dublin , Ireland
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Revel-Vilk S, Szer J, Mehta A, Zimran A. How we manage Gaucher Disease in the era of choices. Br J Haematol 2018; 182:467-480. [PMID: 29808905 DOI: 10.1111/bjh.15402] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Treatment of Gaucher Disease (GD) is now beset with the abundance of therapeutic options for an individual patient, making the choice of therapy complex for both expert and non-expert clinicians. The pathogenesis of all disease manifestations is a gene mutation-driven deficiency of glucocerebrosidase, but the clinical expression and response of each of the clinical manifestations to different therapies can be difficult to predict. Enzyme replacement therapy has been available since 1991 and is well-established, with known efficacy and minimal toxicity. Of interest, the three available enzymes are distinct molecules and were registered as new products, not biosimilars. Oral substrate reduction therapy has undergone a revitalisation with a newly approved agent in this class for which some efficacy and toxicity questions have been raised. Herein we present our approach to the management of GD in the era of choices, including a new algorithm for how to manage a newly diagnosed patient.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Clinic, Shaare Zedek Medical Centre, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Jeff Szer
- Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Atul Mehta
- Department of Haematology, Royal Free Hospital, London, UK
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Centre, Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Lalonde ME, Durocher Y. Therapeutic glycoprotein production in mammalian cells. J Biotechnol 2017; 251:128-140. [DOI: 10.1016/j.jbiotec.2017.04.028] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 12/12/2022]
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Kallemeijn WW, Scheij S, Hoogendoorn S, Witte MD, Herrera Moro Chao D, van Roomen CPAA, Ottenhoff R, Overkleeft HS, Boot RG, Aerts JMFG. Investigations on therapeutic glucocerebrosidases through paired detection with fluorescent activity-based probes. PLoS One 2017; 12:e0170268. [PMID: 28207759 PMCID: PMC5313132 DOI: 10.1371/journal.pone.0170268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/30/2016] [Indexed: 01/14/2023] Open
Abstract
Deficiency of glucocerebrosidase (GBA) causes Gaucher disease (GD). In the common non-neuronopathic GD type I variant, glucosylceramide accumulates primarily in the lysosomes of visceral macrophages. Supplementing storage cells with lacking enzyme is accomplished via chronic intravenous administration of recombinant GBA containing mannose-terminated N-linked glycans, mediating the selective uptake by macrophages expressing mannose-binding lectin(s). Two recombinant GBA preparations with distinct N-linked glycans are registered in Europe for treatment of type I GD: imiglucerase (Genzyme), contains predominantly Man(3) glycans, and velaglucerase (Shire PLC) Man(9) glycans. Activity-based probes (ABPs) enable fluorescent labeling of recombinant GBA preparations through their covalent attachment to the catalytic nucleophile E340 of GBA. We comparatively studied binding and uptake of ABP-labeled imiglucerase and velaglucerase in isolated dendritic cells, cultured human macrophages and living mice, through simultaneous detection of different GBAs by paired measurements. Uptake of ABP-labeled rGBAs by dendritic cells was comparable, as well as the bio-distribution following equimolar intravenous administration to mice. ABP-labeled rGBAs were recovered largely in liver, white-blood cells, bone marrow and spleen. Lungs, brain and skin, affected tissues in severe GD types II and III, were only poorly supplemented. Small, but significant differences were noted in binding and uptake of rGBAs in cultured human macrophages, in the absence and presence of mannan. Mannan-competed binding and uptake were largest for velaglucerase, when determined with single enzymes or as equimolar mixtures of both enzymes. Vice versa, imiglucerase showed more prominent binding and uptake not competed by mannan. Uptake of recombinant GBAs by cultured macrophages seems to involve multiple receptors, including several mannose-binding lectins. Differences among cells from different donors (n = 12) were noted, but the same trends were always observed. Our study suggests that further insight in targeting and efficacy of enzyme therapy of individual Gaucher patients could be obtained by the use of recombinant GBA, trace-labeled with an ABP, preferably equipped with an infrared fluorophore or other reporter tag suitable for in vivo imaging.
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Affiliation(s)
- Wouter W. Kallemeijn
- Department of Biochemistry, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia Scheij
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sascha Hoogendoorn
- Department of Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Martin D. Witte
- Department of Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Daniela Herrera Moro Chao
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy P. A. A. van Roomen
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Roelof Ottenhoff
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Herman S. Overkleeft
- Department of Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Rolf G. Boot
- Department of Biochemistry, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes M. F. G. Aerts
- Department of Biochemistry, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Elstein D, Burrow TA, Charrow J, Giraldo P, Mehta A, Pastores GM, Lee HM, Mellgard B, Zimran A. Home infusion of intravenous velaglucerase alfa: Experience from pooled clinical studies in 104 patients with type 1 Gaucher disease. Mol Genet Metab 2017; 120:111-115. [PMID: 27614581 DOI: 10.1016/j.ymgme.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Abstract
The introduction of a home therapy option during clinical trials of velaglucerase alfa in patients with type 1 Gaucher disease marked the first time that home infusions have been permitted during a clinical trial for an investigational drug for Gaucher disease. Home infusions were an available option in 4 open-label velaglucerase alfa clinical studies to eligible patients who received their initial infusions at a clinic. Patients who participated in the home therapy option and received at least 10% of their infusions at home (n=100) received a range of 11.6%-100% of their scheduled infusions at home (median 87.5%), excluding infusions received at the clinic during protocol-mandated visits. The length of time over which individual patients received home therapy ranged from 13days to 4.56years (median 0.57years). During the time that home therapy was available, 2904 of 3572 (81.3%) infusions were administered at home. Ten patients experienced 62 infusion-related adverse events (IRAEs) during 38 home infusions, with malaise, pain, hypertension, fatigue, and headache being reported most frequently. No notable differences were found between the type and severity of IRAEs experienced at home and those experienced at the clinic. Home infusions administered by trained and qualified medical personnel were successfully introduced into the velaglucerase alfa clinical development program, and fewer than 10% of patients experienced IRAEs in the home setting. Local labeling and practice guidelines should be consulted for administration of velaglucerase alfa infusions at home.
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Affiliation(s)
- Deborah Elstein
- Shaare Zedek Medical Center and Hadassah Medical School, Jerusalem, Israel.
| | | | - Joel Charrow
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Pilar Giraldo
- CIBER de Enfermedades Raras, Spain; Translational Research Unit, IIS Aragon, Zaragoza, Spain
| | | | - Gregory M Pastores
- University College Dublin, Dublin, Ireland; The Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Ari Zimran
- Shaare Zedek Medical Center and Hadassah Medical School, Jerusalem, Israel
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Dumont J, Euwart D, Mei B, Estes S, Kshirsagar R. Human cell lines for biopharmaceutical manufacturing: history, status, and future perspectives. Crit Rev Biotechnol 2016; 36:1110-1122. [PMID: 26383226 PMCID: PMC5152558 DOI: 10.3109/07388551.2015.1084266] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/10/2015] [Accepted: 07/26/2015] [Indexed: 01/25/2023]
Abstract
Biotherapeutic proteins represent a mainstay of treatment for a multitude of conditions, for example, autoimmune disorders, hematologic disorders, hormonal dysregulation, cancers, infectious diseases and genetic disorders. The technologies behind their production have changed substantially since biotherapeutic proteins were first approved in the 1980s. Although most biotherapeutic proteins developed to date have been produced using the mammalian Chinese hamster ovary and murine myeloma (NS0, Sp2/0) cell lines, there has been a recent shift toward the use of human cell lines. One of the most important advantages of using human cell lines for protein production is the greater likelihood that the resulting recombinant protein will bear post-translational modifications (PTMs) that are consistent with those seen on endogenous human proteins. Although other mammalian cell lines can produce PTMs similar to human cells, they also produce non-human PTMs, such as galactose-α1,3-galactose and N-glycolylneuraminic acid, which are potentially immunogenic. In addition, human cell lines are grown easily in a serum-free suspension culture, reproduce rapidly and have efficient protein production. A possible disadvantage of using human cell lines is the potential for human-specific viral contamination, although this risk can be mitigated with multiple viral inactivation or clearance steps. In addition, while human cell lines are currently widely used for biopharmaceutical research, vaccine production and production of some licensed protein therapeutics, there is a relative paucity of clinical experience with human cell lines because they have only recently begun to be used for the manufacture of proteins (compared with other types of cell lines). With additional research investment, human cell lines may be further optimized for routine commercial production of a broader range of biotherapeutic proteins.
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Treatment-naïve Gaucher disease patients achieve therapeutic goals and normalization with velaglucerase alfa by 4years in phase 3 trials. Blood Cells Mol Dis 2016; 68:153-159. [PMID: 27839979 DOI: 10.1016/j.bcmd.2016.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022]
Abstract
Gaucher disease is an inherited metabolic disease characterized by β-glucocerebrosidase deficiency and commonly treated with enzyme replacement therapy (ERT). The efficacy of ERT with velaglucerase alfa was assessed based on the achievement of published therapeutic goals and the normalization of disease parameters in 39 treatment-naïve patients with type 1 Gaucher disease, 6 to 62years of age, enrolled in phase 3 clinical trials. After 4years of ERT, therapeutic goals for thrombocytopenia and splenomegaly had been achieved in 100% of patients; goals for anemia and hepatomegaly had been achieved in 95% and 94% of patients, respectively. Consistent with the goal for bone mineral density, lumbar spine bone density improved in 87% of patients ≥18years of age. At year 4, compared with clinical ranges for healthy individuals, 86% of patients with a low baseline hemoglobin concentration had normalized, 60% with a low baseline platelet count had normalized, 67% with baseline splenomegaly had normalized, 58% with hepatomegaly had normalized, and lumbar spine bone density had normalized in 53% of adults. The decade-old therapeutic goals do not reflect the potential for normalization of clinical parameters in ERT-treated patients. Goals consistent with normalization or near-normalization should be considered. ClinicalTrials.gov identifiers: NCT00430625, NCT00553631, NCT00635427.
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Serratrice C, Carballo S, Serratrice J, Stirnemann J. Imiglucerase in the management of Gaucher disease type 1: an evidence-based review of its place in therapy. CORE EVIDENCE 2016; 11:37-47. [PMID: 27790078 PMCID: PMC5072572 DOI: 10.2147/ce.s93717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Gaucher disease is the first lysosomal disease to benefit from enzyme replacement therapy, thus serving as model for numerous other lysosomal diseases. Alglucerase was the first glucocerebrosidase purified from placental extracts, and this was then replaced by imiglucerase – a Chinese hamster ovary cell-derived glucocerebrosidase. Aim The aim was to review the evidence underlying the use of imiglucerase in Gaucher disease type 1 Evidence review Data from clinical trials and Gaucher Registries were analyzed. Conclusion Imiglucerase has been prescribed and found to have an excellent efficacy and safety profile. We report herein the evidence-based data published for 26 years justifying the use of imiglucerase.
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Affiliation(s)
- Christine Serratrice
- Department of Internal Medicine and Rehabilitation, Geneva University Hospital, Thonex, Switzerland
| | - Sebastian Carballo
- Department of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Jacques Serratrice
- Department of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Jérome Stirnemann
- Department of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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Van Rossum A, Holsopple M. Enzyme Replacement or Substrate Reduction? A Review of Gaucher Disease Treatment Options. Hosp Pharm 2016; 51:553-63. [PMID: 27559188 DOI: 10.1310/hpj5107-553] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Gaucher disease is a rare lysosomal storage disease resulting from a deficiency or reduced activity in the acid β-glucocosidase enzyme. Only 1 treatment option was available for 15 years, but several new treatment options have come to market since 2003. OBJECTIVE The article will detail the pathophysiology and review current therapies in the literature for all 3 major clinical types of Gaucher disease, with a focus on considerations for selecting therapy in type 1 disease. METHODS Extracted and summarized applicable studies and reviews from Cochrane Review, ClinicalTrials.gov, CINAHL, IPA, and PubMed. RESULTS Enzyme replacement therapy is preferred for the management of Gaucher disease. Current literature does not favor any enzyme replacement product over another. However, velaglucerase alfa and taliglucerase alfa theoretically have a lower risk of immunogenicity reactions compared with imiglucerase. Alternative treatments for type 1 disease include substrate reduction therapy; however, these treatments require evaluation of patient-specific variables (eg, genotype evaluation, renal function) and consideration of adverse effect and dosing profiles. Evaluation of current literature found no substrate reduction therapy is preferred over another. There are no approved therapies for type 2 and type 3 disease, but enzyme replacement therapy may be used with limited efficacy for symptom management. CONCLUSION Enzyme replacement therapy is preferred for treating type 1 Gaucher disease and substrate replacement therapy may be considered in patients who do not tolerate or cannot receive enzyme replacement therapy.
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Gras-Colomer E, Martínez-Gómez MA, Moya-Gil A, Fernandez-Zarzoso M, Merino-Sanjuan M, Climente-Martí M. Cellular Uptake of Glucocerebrosidase in Gaucher Patients Receiving Enzyme Replacement Treatment. Clin Pharmacokinet 2016; 55:1103-13. [PMID: 27083470 DOI: 10.1007/s40262-016-0387-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Enzyme replacement therapy (ERT) is currently the standard treatment for patients with Gaucher disease type I (GD1), but the pharmacokinetics have hardly been studied. This study aimed to quantify in vivo enzyme activity in peripheral leukocytes from patients receiving long-term treatment with imiglucerase or velaglucerase for GD1, and set out to assess the process of enzymatic uptake by peripheral leukocytes. METHODS A prospective semi-experimental study was conducted. Four time points for blood withdrawal were planned per patient to quantify the intra-leukocyte enzymatic activity. In order to assess the uptake process, the rate of enzyme uptake by leukocytes (Rupt) and the rate of enzyme disappearance from the plasma (Rdis) were estimated. RESULTS Eight GD1 patients were included. Intra-leukocyte activity was 24.31 mU/mL [standard deviation (SD) 6.32 mU/mL; coefficient of variation (CV) 25.96 %] at baseline and 27.14 mU/mL (SD 6.96 mU/mL; CV 25.65 %) at 15 min post-perfusion. The relationships with the administered dose were linear. The Rupt value was 37.73 mU/mL/min [95 % confidence interval (CI) 25.63-49.84] and showed a linear correlation with the administered enzyme dose (p < 0.05), and the Rdis value was 189.43 mU/mL/min (95 % CI 80.31-298.55) and also showed a linear correlation with the dose (p < 0.05). CONCLUSION This was the first in vivo study to quantify the accumulated enzymatic activity in patients receiving ERT for GD1. It showed that intra-leukocyte activity at baseline and at 15 min post-perfusion could be used as a possible marker for therapeutic individualization in patients receiving ERT for GD1.
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Affiliation(s)
- Elena Gras-Colomer
- Pharmacy Service, Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain. .,FISABIO, Hospital Universitario Dr. Peset, Valencia, Spain.
| | - María Amparo Martínez-Gómez
- Pharmacy Service, Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain.,FISABIO, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Ana Moya-Gil
- Pharmacy Service, Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain
| | | | - Matilde Merino-Sanjuan
- Pharmacy and Pharmaceutical Technology Department, Universidad de Valencia, Valencia, Spain.,Molecular Recognition and Technological Development Institute, Centro Mixto Universidad Politécnica de Valencia, Universidad de Valencia, Valencia, Spain
| | - Mónica Climente-Martí
- Pharmacy Service, Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain.,Pharmacy and Pharmaceutical Technology Department, Universidad de Valencia, Valencia, Spain
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Pastores GM, Turkia HB, Gonzalez DE, Ida H, Tantawy AAG, Qin Y, Qiu Y, Dinh Q, Zimran A. Development of anti-velaglucerase alfa antibodies in clinical trial-treated patients with Gaucher disease. Blood Cells Mol Dis 2016; 59:37-43. [PMID: 27282565 DOI: 10.1016/j.bcmd.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023]
Abstract
Anti-drug antibodies may develop with biological therapies, possibly leading to a reduction of treatment efficacy and to allergic and other adverse reactions. Patients with Gaucher disease were tested for anti-drug antibodies every 6 or 12weeks in clinical studies of velaglucerase alfa enzyme replacement therapy, as part of a range of safety endpoints. In 10 studies between April 2004 and March 2015, 289 patients aged 2-84years (median 43years) were assessed for the development of anti-velaglucerase alfa antibodies. Sixty-four patients were treatment-naïve at baseline and 225 patients were switched to velaglucerase alfa from imiglucerase treatment. They received velaglucerase alfa treatment for a median of 36.4weeks (interquartile range 26.4-155.4weeks). Four patients (1.4%) became positive for anti-velaglucerase alfa IgG antibodies, two of whom had antibodies that were neutralizing in vitro, but there were no apparent changes in patients' platelet counts, hemoglobin levels or levels of CCL18 and chitotriosidase, suggestive of clinical deterioration after anti-velaglucerase alfa antibodies were detected, and no infusion-related adverse events were reported. Less than 2% of patients exposed to velaglucerase alfa tested positive for antibodies and there was no apparent correlation between anti-velaglucerase alfa antibodies and adverse events or pharmacodynamic or clinical responses.
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Affiliation(s)
| | | | | | - Hiroyuki Ida
- The Jikei University School of Medicine, Tokyo, Japan.
| | | | | | | | | | - Ari Zimran
- Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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28
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Laudemann K, Moos L, Mengel E, Lollert A, Hoffmann C, Brixius-Huth M, Wagner D, Düber C, Staatz G. Evaluation of treatment response to enzyme replacement therapy with Velaglucerase alfa in patients with Gaucher disease using whole-body magnetic resonance imaging. Blood Cells Mol Dis 2016; 57:35-41. [DOI: 10.1016/j.bcmd.2015.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
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Smith L, Rhead W, Charrow J, Shankar SP, Bavdekar A, Longo N, Mardach R, Harmatz P, Hangartner T, Lee HM, Crombez E, Pastores GM. Long-term velaglucerase alfa treatment in children with Gaucher disease type 1 naïve to enzyme replacement therapy or previously treated with imiglucerase. Mol Genet Metab 2016; 117:164-71. [PMID: 26043810 DOI: 10.1016/j.ymgme.2015.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gaucher Disease type 1 (GD1) often manifests in childhood. Early treatment with enzyme replacement therapy (ERT) may prevent disease complications. We report the assessment of velaglucerase alfa ERT in pediatric GD1 patients who participated in a long-term extension study (HGT-GCB-044, ClinicalTrials.gov Identifier NCT00635427). METHODS Safety and efficacy were evaluated in pediatric patients receiving velaglucerase alfa 30-60U/kg by intravenous infusion every other week. In addition to key hematological and visceral efficacy assessments, exploratory assessments conducted specifically in pediatric patients included evaluation of height, bone age, bone marrow burden, and Tanner stage of puberty. RESULTS The study included 24 pediatric patients. Fifteen patients were naïve to ERT on entry into the preceding trials TKT032 (12-month trial) or HGT-GCB-039 (9-month trial): in the preceding trials, ten of these 15 patients received velaglucerase alfa and five patients received imiglucerase ERT. Nine patients in the study were previously treated with imiglucerase for >30months and were switched to velaglucerase alfa in the preceding trial TKT034 (12-month trial). Cumulative ERT exposure in the clinical studies ranged from 2.0 to 5.8years. Three serious adverse events, including a fatal convulsion, were reported; none were deemed related to velaglucerase alfa. One patient tested positive for anti-velaglucerase alfa antibodies. An efficacy assessment at 24months showed that velaglucerase alfa had positive effects on primary hematological and visceral parameters in treatment-naïve patients, which were maintained with longer-term treatment. Disease parameters were stable in patients switched from long-term imiglucerase ERT. Exploratory results may suggest benefits of early treatment to enable normal growth in pediatric patients. CONCLUSION The safety profile and clinical response seen in pediatric patients are consistent with results reported in adults.
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Affiliation(s)
- Laurie Smith
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - William Rhead
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Joel Charrow
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Suma P Shankar
- Department of Human Genetics, Division of Medical Genetics, School of Medicine, Emory University, Atlanta, GA, USA; Department of Ophthalmology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Ashish Bavdekar
- Pediatric Gastroenterology Department, King Edward Memorial Hospital Research Centre, Pune, India
| | - Nicola Longo
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | | | - Paul Harmatz
- Department of Gastroenterology, Hepatology, and Nutrition, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Thomas Hangartner
- Department of Biomedical, Industrial, & Human Factors Engineering, Wright State University, Dayton, OH, USA
| | - Hak-Myung Lee
- Biostatistics & Statistical Programming Department, Shire, Lexington, MA, USA
| | | | - Gregory M Pastores
- Department of Medicine/National Centre for Inherited Metabolic Disorders, Mater Misericordiae University Hospital, Dublin, Ireland
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Abstract
Research and drug developments fostered under orphan drug product development programs have greatly assisted the introduction of efficient and safe enzyme-based therapies for a range of rare disorders. The introduction and regulatory approval of 20 different recombinant enzymes has enabled, often for the first time, effective enzyme-replacement therapy for some lysosomal storage disorders, including Gaucher (imiglucerase, taliglucerase, and velaglucerase), Fabry (agalsidase alfa and beta), and Pompe (alglucosidase alfa) diseases and mucopolysaccharidoses I (laronidase), II (idursulfase), IVA (elosulfase), and VI (galsulfase). Approved recombinant enzymes are also now used as therapy for myocardial infarction (alteplase, reteplase, and tenecteplase), cystic fibrosis (dornase alfa), chronic gout (pegloticase), tumor lysis syndrome (rasburicase), leukemia (L-asparaginase), some collagen-based disorders such as Dupuytren's contracture (collagenase), severe combined immunodeficiency disease (pegademase bovine), detoxification of methotrexate (glucarpidase), and vitreomacular adhesion (ocriplasmin). The development of these efficacious and safe enzyme-based therapies has occurred hand in hand with some remarkable advances in the preparation of the often specifically designed recombinant enzymes; the manufacturing expertise necessary for commercial production; our understanding of underlying mechanisms operative in the different diseases; and the mechanisms of action of the relevant recombinant enzymes. Together with information on these mechanisms, safety findings recorded so far on the various adverse events and problems of immunogenicity of the recombinant enzymes used for therapy are presented.
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A multicenter, open-label extension study of velaglucerase alfa in Japanese patients with Gaucher disease: Results after a cumulative treatment period of 24months. Blood Cells Mol Dis 2015; 59:140-7. [PMID: 27241455 DOI: 10.1016/j.bcmd.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/05/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022]
Abstract
Enzyme replacement therapy (ERT) with exogenous glucocerebrosidase is indicated to treat symptomatic Gaucher disease (GD), a rare, inherited metabolic disorder. ERT with velaglucerase alfa, which is produced in a human cell line using gene activation technology, was studied in a 12-month phase III trial in Japanese patients with type 1 or 3 GD who were switched from imiglucerase ERT (n=6); the current, open-label, 12-month extension study was designed to assess longer-term safety and efficacy. Two adult and three pediatric patients (aged <18years) were enrolled into the extension study. Every-other-week intravenous infusions were administered for 63-78weeks at average doses between 51.5 and 60.7units/kg. Three non-serious adverse events were considered related to velaglucerase alfa treatment, but no patient discontinued from the study. Six serious but non-drug-related adverse events were reported. No patient tested positive for anti-velaglucerase alfa antibodies. Hemoglobin concentrations, platelet counts, and liver and spleen volumes (normalized to body weight) in these patients were generally stable over a cumulative 24-month period from the baseline of the parent trial. The data suggest that velaglucerase alfa was well tolerated and maintained clinical stability in Japanese GD patients over 2years after switching from imiglucerase. ClinicalTrials.gov identifier NCT01842841.
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Elstein D, Abrahamov A, Oz A, Arbel N, Baris H, Zimran A. 13,845 home therapy infusions with velaglucerase alfa exemplify safety of velaglucerase alfa and increased compliance to every-other-week intravenous enzyme replacement therapy for Gaucher disease. Blood Cells Mol Dis 2015; 55:415-8. [PMID: 26460268 DOI: 10.1016/j.bcmd.2015.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lifelong intravenous (IV) enzyme replacement therapy (ERT) every other week for Gaucher disease is appreciated as decreasing quality of life in a palpable way. OBJECTIVE To review the Israeli experience with the home therapy option for IV velaglucerase alfa (Shire, Lexington MA USA) infusions every-other-week in the clinical trial context, in the early access program (EAP) during a shortage with the standard commercial ERT, and currently with the commercially available drug (VPRIV, Shire). RESULTS Among 24 patients participating in trials, 1654 infusions were at home; in the EAP and commercial setting, 12,191 infusions were performed at home for a total of 154 patients with 98.4% compliance. There were no incidents of serious adverse events. CONCLUSION This is the first review of experience of 174 patients and 13,845 intravenous infusions of velaglucerase alfa for Gaucher in the home setting, underscoring its safety.
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Affiliation(s)
- Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Aya Abrahamov
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anat Oz
- Medison Pharma Ltd, Petach Tikva, Israel
| | | | - Hagit Baris
- Genetics Institute, Rambam Medical Center, Haifa, Israel
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
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Zimran A, Wang N, Ogg C, Crombez E, Cohn GM, Elstein D. Seven-year safety and efficacy with velaglucerase alfa for treatment-naïve adult patients with type 1 Gaucher disease. Am J Hematol 2015; 90:577-83. [PMID: 25903392 PMCID: PMC5033020 DOI: 10.1002/ajh.24040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 11/29/2022]
Abstract
Velaglucerase alfa is a human β‐glucocerebrosidase approved for Gaucher disease type 1 (GD1) treatment. This report summarizes the 7‐year experience of the now‐completed phase I/II and extension studies of adult GD1 patients who received velaglucerase alfa. Ten patients who completed the 9‐month, phase I/II study entered the extension trial TKT025EXT, of which eight completed this study. Doses were reduced after a cumulative treatment period of 15 to 18 months. Although all patients experienced ≥1 adverse event, no patient withdrew due to a drug‐related adverse event or required premedication. No patient developed anti‐drug antibodies, compliance remained high (median 98%), and seven of eight eligible patients transitioned to home infusions under supervision by healthcare professionals. Statistically significant improvements were observed for efficacy parameters: mean percentage changes from baseline (95% confidence intervals) were 18% (12%, 24%) for hemoglobin concentration, 115% (66%, 164%) for platelet counts, and −42% (−53%, −31%) and −78% (−94%, −62%) for liver and spleen volumes, respectively. Improvements were also observed for secondary endpoints chitotriosidase and CCL18 levels and exploratory endpoints (bone mineral density [BMD], bone marrow burden [BMB] scores). Normalization to near‐normalization of individuals' hemoglobin concentrations, platelet counts, liver volumes, and BMB scores was observed, and there were marked improvements in spleen volumes, biomarkers, and BMD. TKT025EXT represents the longest, prospective clinical trial for GD1 treatment to date and suggests that, despite dose reduction within 18 months of initiating therapy, velaglucerase alfa was generally well tolerated and was associated with marked improvement, including near normalization and/or normalization of key GD1 disease parameters. Am. J. Hematol. 90:577–583, 2015. © 2015 The Authors. American Journal of Hematology published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ari Zimran
- Shaare Zedek Medical Center, affiliated with the Hebrew University‐Hadassah Medical SchoolJerusalem Israel
| | | | | | | | | | - Deborah Elstein
- Shaare Zedek Medical Center, affiliated with the Hebrew University‐Hadassah Medical SchoolJerusalem Israel
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Hughes DA, Gonzalez DE, Lukina EA, Mehta A, Kabra M, Elstein D, Kisinovsky I, Giraldo P, Bavdekar A, Hangartner TN, Wang N, Crombez E, Zimran A. Velaglucerase alfa (VPRIV) enzyme replacement therapy in patients with Gaucher disease: Long-term data from phase III clinical trials. Am J Hematol 2015; 90:584-91. [PMID: 25801797 PMCID: PMC4654249 DOI: 10.1002/ajh.24012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/20/2015] [Accepted: 03/12/2015] [Indexed: 12/29/2022]
Abstract
Type 1 Gaucher disease is an inherited lysosomal enzyme deficiency with variable age of symptom onset. Common presenting signs include thrombocytopenia, anemia, hepatosplenomegaly, bone abnormalities, and, additionally in children, growth failure. Fifty-seven patients aged 3–62 years at the baseline of two phase III trials for velaglucerase alfa treatment were enrolled in the single extension study. In the extension, they received every-other-week velaglucerase alfa intravenous infusions for 1.2–4.8 years at 60 U/kg, although 10 patients experienced dose reduction. No patient experienced a drug-related serious adverse event or withdrew due to an adverse event. One patient died following a convulsion that was reported as unrelated to the study drug. Only one patient tested positive for anti-velaglucerase alfa antibodies. Combining the experience of the initial phase III trials and the extension study, significant improvements were observed in the first 24 months from baseline in hematology variables, organ volumes, plasma biomarkers, and, in adults, the lumbar spine bone mineral density Z-score. Improvements were maintained over longer-term treatment. Velaglucerase alfa had a good long-term safety and tolerability profile, and patients continued to respond clinically, which is consistent with the results of the extension study to the phase I/II trial of velaglucerase alfa. EudraCT number 2008-001965-27; http://www.clinicaltrials.gov identifier NCT00635427. Am. J. Hematol. 90:584–591, 2015. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Derralynn A. Hughes
- Department of HaematologyRoyal Free HospitalLondon United Kingdom
- Department of HaematologyUniversity College LondonLondon United Kingdom
| | - Derlis E. Gonzalez
- Instituto Privado de Hematología e Investigación Clínica – IPHICAsunción Paraguay
| | - Elena A. Lukina
- Department of Orphan DiseasesHematology Research CenterMoscow Russia
| | - Atul Mehta
- Department of HaematologyRoyal Free HospitalLondon United Kingdom
- Department of HaematologyUniversity College LondonLondon United Kingdom
| | - Madhulika Kabra
- Pediatrics DepartmentAll India Institute of Medical SciencesNew Delhi India
| | - Deborah Elstein
- Gaucher ClinicShaare Zedek Medical Center, affiliated with the Hebrew University‐Hadassah Medical SchoolJerusalem Israel
| | | | - Pilar Giraldo
- Medicina Metabólica HereditariaCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)Zaragoza Spain
- Grupo de Estudio de Enfermedades Hematologícas y MetabolicasHospital Universitario Miguel ServetZaragoza Spain
| | - Ashish Bavdekar
- Pediatric Gastroenterology DepartmentKing Edward Memorial Hospital Research CentrePune India
| | - Thomas N. Hangartner
- Department of Biomedical Industrial & Human Factors EngineeringWright State UniversityDayton Ohio
| | - Nan Wang
- Biostatistics & Statistical Programming DepartmentShireLexington Massachusetts
| | | | - Ari Zimran
- Gaucher ClinicShaare Zedek Medical Center, affiliated with the Hebrew University‐Hadassah Medical SchoolJerusalem Israel
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Elstein D, Mehta A, Hughes DA, Giraldo P, Charrow J, Smith L, Shankar SP, Hangartner TN, Kunes Y, Wang N, Crombez E, Zimran A. Safety and efficacy results of switch from imiglucerase to velaglucerase alfa treatment in patients with type 1 Gaucher disease. Am J Hematol 2015; 90:592-7. [PMID: 25776130 DOI: 10.1002/ajh.24007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/20/2015] [Accepted: 03/10/2015] [Indexed: 11/10/2022]
Abstract
Gaucher disease (GD) is a lysosomal storage disorder; symptomatic patients with type 1 GD need long-term disease-specific therapy of which the standard of care has been enzyme replacement therapy (ERT). Thirty-eight of 40 patients (aged 9-71 years) clinically stable on ERT with imiglucerase, safely switched to a comparable dose of velaglucerase alfa (units/kg) during TKT034, a 12-month, open-label clinical study, and for 10-50 months in an extension study. The most common adverse events (AEs) judged to be drug-related in the extension were fatigue and bone pain. No drug-related serious AEs were reported. No AEs led to study withdrawal. At 24 months from baseline (baseline being TKT034 week 0), patients had generally stable hemoglobin, platelet, spleen, liver, and bone density parameters. Nevertheless, dose adjustment based on the achievement of therapeutic goals was permitted, and 10 patients, including seven patients who had platelet counts <100 × 10(9) /L at baseline, were given at least one 15 U/kg-dose increase during the extension. Trends indicative of improvement in platelet count and spleen volume, and decreasing levels of GD biomarkers, chitotriosidase and CCL18, were observed. Immunogenicity was seen in one patient positive for anti-imiglucerase antibodies at baseline. This patient tested positive for anti-velaglucerase alfa antibodies in TKT034, with low antibody concentrations, and throughout the extension study; however, the patient continued to receive velaglucerase alfa without clinical deterioration. In conclusion, clinically stable patients can be switched from imiglucerase to velaglucerase alfa ERT and maintain or achieve good therapeutic outcomes.
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Affiliation(s)
- Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University‐Hadassah Medical SchoolJerusalem Israel
| | - Atul Mehta
- Department of HaematologyRoyal Free HospitalLondon United Kingdom
- Department of HaematologyUniversity College LondonLondon United Kingdom
| | - Derralynn A. Hughes
- Department of HaematologyRoyal Free HospitalLondon United Kingdom
- Department of HaematologyUniversity College LondonLondon United Kingdom
| | - Pilar Giraldo
- Medicina Metabólica HereditariaCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)Zaragoza Spain
- Grupo de Estudio de Enfermedades Hematologícas y Metabolicas, Hospital Universitario Miguel ServetZaragoza Spain
| | - Joel Charrow
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of ChicagoChicago Illinois
| | - Laurie Smith
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas City Missouri
| | - Suma P. Shankar
- Departments of Human Genetics and Ophthalmology, School of MedicineEmory UniversityAtlanta Georgia
| | - Thomas N. Hangartner
- Department of Biomedical, Industrial, & Human Factors EngineeringWright State UniversityDayton Ohio
| | - Yune Kunes
- Bioanalytical and BioMarker DevelopmentShireLexington Massachusetts
| | - Nan Wang
- Biostatistics & Statistical Programming DepartmentShireLexington Massachusetts
| | | | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University‐Hadassah Medical SchoolJerusalem Israel
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Shemesh E, Deroma L, Bembi B, Deegan P, Hollak C, Weinreb NJ, Cox TM. Enzyme replacement and substrate reduction therapy for Gaucher disease. Cochrane Database Syst Rev 2015; 2015:CD010324. [PMID: 25812601 PMCID: PMC8923052 DOI: 10.1002/14651858.cd010324.pub2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gaucher disease, a rare disorder, is caused by inherited deficiency of the enzyme glucocerebrosidase. It is unique among the ultra-orphan disorders in that four treatments are currently approved by various regulatory authorities for use in routine clinical practice. Hitherto, because of the relatively few people affected worldwide, many of whom started therapy during a prolonged period when there were essentially no alternatives to imiglucerase, these treatments have not been systematically evaluated in studies such as randomized controlled trials now considered necessary to generate the highest level of clinical evidence. OBJECTIVES To summarize all available randomized controlled study data on the efficacy and safety of enzyme replacement therapies and substrate reduction therapy for treating Gaucher disease. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register. Additional searches were conducted on ClinicalTrials.gov for any ongoing studies with potential interim results, and through PubMed. We also searched the reference lists of relevant articles and reviews.Date of last search: 07 August 2014. SELECTION CRITERIA All randomized and quasi-randomized controlled studies (including open-label studies and cross-over studies) assessing enzyme replacement therapy or substrate reduction therapy, or both, in all types of Gaucher disease were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias in the included studies, and extracted relevant data. MAIN RESULTS Of the 488 studies retrieved by the electronic searches, eight met the inclusion criteria and were analysed (300 participants). Response parameters were restricted to haemoglobin concentration, platelet count, spleen and liver volume and serum biomarkers (chitotriosidase and CCL18). Only one publication reported a 'low risk of bias' score in all parameters assessed, and all studies included were randomized.Four studies reported the responses to enzyme replacement therapy of previously untreated individuals with type 1 Gaucher disease. Two studies investigated maintenance enzyme replacement therapy in people with stable type 1 Gaucher disease previously treated for at least two years. One study compared substrate reduction therapy, enzyme replacement therapy and a combination thereof as maintenance therapy in people with type 1 Gaucher disease previously treated with enzyme replacement therapy. One study examined substrate reduction therapy in people with chronic neuronopathic (type 3) Gaucher disease who continued to receive enzyme replacement therapy.Treatment-naïve participants had similar increases in haemoglobin when comparing those receiving imiglucerase or alglucerase at 60 units/kg, imiglucerase or velaglucerase alfa at 60 U/kg, taliglucerase alfa at 30 units/kg or 60 units/kg, and velaglucerase alfa at 45 units/g or 60 units/kg. For platelet count response in participants with intact spleens, a benefit for imiglucerase over velaglucerase alfa at 60 units/kg was observed, mean difference -79.87 (95% confidence interval -137.57 to -22.17). There were no other significant differences in platelet count response when comparing different doses of velaglucerase alfa and of taliglucerase alfa, and when comparing imiglucerase to alglucerase. Spleen and liver volume reductions were not significantly different in any enzyme replacement therapy product or dose comparison study. Although a dose effect on serum biomarkers was not seen after nine months, a significantly greater reduction with higher dose was reported after 12 months in the velaglucerase study, mean difference 16.70 (95% confidence intervaI 1.51 to 31.89). In the two enzyme replacement therapy maintenance studies comparing infusions every two weeks and every four weeks, there were no significant differences in haemoglobin concentration, platelet count, and spleen and liver volumes over a 6 to 12 month period when participants were treated with the same cumulative dose.A total of 25 serious adverse events were reported, nearly all deemed unrelated to treatment.There are, as yet, no randomized trials of substrate reduction therapy in treatment-naïve patients that can be evaluated. Miglustat monotherapy appeared as effective as continued enzyme replacement therapy for maintenance of hematological, organ and biomarker responses in people with type 1 Gaucher disease previously treated with imiglucerase for at least two years. In those with neuronopathic Gaucher disease, no significant improvements in haemoglobin concentration, platelet count or organ volumes occurred when enzyme replacement therapy was augmented with miglustat.One randomized controlled study assessing substrate reduction therapy was published immediately prior to producing the final version of this review, and this, along with a further ongoing study (expected to be published in the near future), will be assessed for eligibility in a future update of the review. AUTHORS' CONCLUSIONS The results reflect the limitations of analysing evidence restricted to prospective randomized controlled trials, especially when dealing with chronic rare diseases. This analysis suggests that, during the first year of treatment, different recombinant glucocerebrosidases are bio-similar and non-inferior in safety and efficacy for surrogate biological response parameters. Enzyme replacement therapy given at 30 to 45 units/kg body weight every two to four weeks was generally as effective as the 60 unit/kg dose for the assessed clinical outcomes. The analysis emphasise the need to determine whether it is realistic to carry out multi-decade prospective clinical trials for rare diseases such as type 1 Gaucher disease. With large treatment effects on the classical manifestations of the disorder, therapeutic investigations in Gaucher disease mandate innovative trial designs and methodology to secure decisive data concerning long-term efficacy and safety - with the realization that knowledge about disease-modifying actions that are sustained are of crucial importance to people with this chronic condition.
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Affiliation(s)
| | - Laura Deroma
- University Hospital "Santa Maria della Misericordia"Regional Coordinator Centre for Rare DiseasesPiazzale Santa Maria della Misericordia 15UdineItaly33100
| | - Bruno Bembi
- University Hospital "Santa Maria della Misericordia"Regional Coordinator Centre for Rare DiseasesPiazzale Santa Maria della Misericordia 15UdineItaly33100
| | - Patrick Deegan
- University of Cambridge and Lysosomal Disorders UnitDepartment of MedicineAddenbrooke's Hospital (PO Box 157)CambridgeUKCB2 0QQ
| | - Carla Hollak
- Academic Medical CenterDepartment of Internal Medicine, Division of Endocrinology & MetabolismPostbus 22660AmsterdamNetherlands1100 DD
| | - Neal J Weinreb
- Northwest Oncology Hematology Associates PAUniversity Research Foundation for Lysosomal Storage Diseases8170 Royal Palm BoulevardCoral SpringsFloridaUSA33433
- University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Timothy M Cox
- Addenbrooke's Hospital (Box 157)Department of MedicineLevel 5, Hills RoadCambridgeCambridgeshireUKCB2 0QQ
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Marcucci G, Zimran A, Bembi B, Kanis J, Reginster JY, Rizzoli R, Cooper C, Brandi ML. Gaucher disease and bone manifestations. Calcif Tissue Int 2014; 95:477-94. [PMID: 25377906 DOI: 10.1007/s00223-014-9923-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/17/2014] [Indexed: 01/25/2023]
Abstract
Gaucher disease is a relatively rare metabolic disease caused by the inherited deficiency of the lysosomal enzyme glucocerebrosidase. Gaucher disease affects multiple organs, among which is the skeleton. Bone involvement occurs frequently in Gaucher disease, and is one of its most debilitating features, reducing the quality of life of patients. Bone status is an important consideration for treatment to ameliorate symptoms and reduce the risk of irreversible complications. We have conducted a systematic review of all the various aspects of Gaucher disease, focusing on different skeletal manifestations, pathophysiology of bone alterations, clinical symptoms, and current diagnostic and therapeutic approaches.
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Affiliation(s)
- Gemma Marcucci
- Head, Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
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Vitner EB, Vardi A, Cox TM, Futerman AH. Emerging therapeutic targets for Gaucher disease. Expert Opin Ther Targets 2014; 19:321-34. [PMID: 25416676 DOI: 10.1517/14728222.2014.981530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Gaucher disease (GD) is an inherited metabolic disorder caused by mutations in the glucocerebrosidase (GBA1) gene. Although infusions of recombinant GBA ameliorate the systemic effects of GD, this therapy has no effect on the neurological manifestations. Patients with the neuronopathic forms of GD (nGD) are often severely disabled and die prematurely. The search for innovative drugs is thus urgent for the neuronopathic forms. AREAS COVERED Here we briefly summarize the available treatments for GD. We then review recent studies of the molecular pathogenesis of GD, which suggest new avenues for therapeutic development. EXPERT OPINION Existing treatments for GD are designed to target the primary consequence of the inborn defects of sphingolipid metabolism, that is, lysosomal accumulation of glucosylceramide (GlcCer). Here we suggest that targeting other pathways, such as those that are activated as a consequence of GlcCer accumulation, may also have salutary clinical effects irrespective of whether excess substrate persists. These pathways include those implicated in neuroinflammation, and specifically, receptor-interacting protein kinase-3 (RIP3) and related components of this pathway, which appear to play a vital role in the pathogenesis of nGD. Once available, inhibitors to components of the RIP kinase pathway will hopefully offer new therapeutic opportunities in GD.
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Affiliation(s)
- Einat B Vitner
- Weizmann Institute of Science, Department of Biological Chemistry , Rehovot 76100 , Israel +972 8 9342353 ; +972 8 9344112 ;
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Kolitz SE, Towfic F, Grossman I, Hayden MR, Zeskind B. Use of genetic technologies to compare medicines. Clin Genet 2014; 86:441-6. [PMID: 25046029 DOI: 10.1111/cge.12462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 11/27/2022]
Abstract
In order to ensure that patients receive the safest and most effective medicines possible, it is often necessary to compare medicines and assess the extent to which they are similar in their clinical impact. Full clinical trials with appropriate endpoints remain the only method to compare the clinical impact of two medicines with absolute certainty. Other available methods (including physicochemical analysis, genomics, and transcriptomics) can provide partial information about certain aspects of a medicine's biological impact, with possible clinical implications. Especially for biologics and non-biological complex drugs, which are more difficult to characterize by physicochemical means than small molecules, genomics and transciptomic studies can yield valuable insights for physicians, regulators, and drug developers. In this review, we cite and summarize a variety of studies that exemplify the emerging science of applying genomics and transcriptomics technologies to compare medicines. We discuss key aspects of experimental design, conduct of genetic assays, and advanced data analysis, all of which are critical for the successful execution of such studies. Finally, we propose new areas for which such studies can be applied to maximize patient benefit and reduce safety issues.
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Affiliation(s)
- S E Kolitz
- Immuneering Corporation, Cambridge, MA, USA
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Elstein D, Haims AH, Zahrieh D, Cohn GM, Zimran A. Impact of velaglucerase alfa on bone marrow burden score in adult patients with type 1 Gaucher disease: 7-Year follow-up. Blood Cells Mol Dis 2014; 53:56-60. [DOI: 10.1016/j.bcmd.2014.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
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Barranger JA, Brady RO, Grabowski GA, Mankin H, Mistry PK, Weinreb NJ. Position statement: National Gaucher Foundation Medical Advisory Board, January 7, 2014. Am J Hematol 2014; 89:457-8. [PMID: 24488939 DOI: 10.1002/ajh.23687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 01/29/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Henry Mankin
- Department of Orthopedic Surgery; Massachusetts General Hospital; Boston MA
| | | | - Neal J. Weinreb
- University Research Foundation for Lysosomal Storage Diseases; Coral Springs FL
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A multicenter open-label treatment protocol (HGT-GCB-058) of velaglucerase alfa enzyme replacement therapy in patients with Gaucher disease type 1: safety and tolerability. Genet Med 2013; 16:359-66. [PMID: 24263462 PMCID: PMC4018500 DOI: 10.1038/gim.2013.154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/23/2013] [Indexed: 12/04/2022] Open
Abstract
Purpose: To evaluate the safety of velaglucerase alfa in patients with type 1 Gaucher disease who received velaglucerase alfa in the US treatment protocol HGT-GCB-058 (ClinicalTrials.gov identifier NCT00954460) during a global supply shortage of imiglucerase. Methods: This multicenter open-label treatment protocol enrolled patients who were either treatment naïve or had been receiving imiglucerase. Patients received intravenous velaglucerase alfa every other week at a dose of 60 U/kg (treatment naïve) or 15–60 U/kg (previously treated). Results: A total of 211 (including six treatment-naïve) patients were enrolled. Among the 205 previously treated patients, 35 (17.1%) experienced an adverse event considered related to study drug. Among the six treatment-naïve patients, one had an adverse event considered related to study drug. Infusion-related adverse events occurred in 28 (13.3%) of the 211 patients and usually occurred during the first three infusions. De novo, nonneutralizing, anti–velaglucerase alfa antibodies developed during treatment in one (<1.0%) previously treated patient and none of the treatment-naïve patients. Conclusion: The currently observed safety profile was consistent with those previously reported for imiglucerase and velaglucerase alfa phase III clinical trials. These results support the safety of initiating treatment with velaglucerase alfa or transitioning patients from imiglucerase therapy to velaglucerase alfa therapy.
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Sirrs S, Casey R, Patterson MA, McNeil C, Paquin W, Amato D. Variation in chitotriosidase values measured on simultaneous samples by two commercial laboratories. Am J Hematol 2013; 88:980. [PMID: 23861203 DOI: 10.1002/ajh.23542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 06/28/2013] [Accepted: 07/09/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Sandra Sirrs
- Adult Metabolic Diseases Clinic; Vancouver British Columbia
- University of British Columbia; Vancouver British Columbia
| | - Robin Casey
- Department of Pediatrics; University of Calgary; Alberta British Columbia
| | | | - Colleen McNeil
- Department of Pediatrics; University of Calgary; Alberta British Columbia
| | - Wendy Paquin
- Adult Metabolic Diseases Clinic; Vancouver British Columbia
| | - Dominick Amato
- Department of Medicine, Mount Sinai Hospital; Toronto Ontario
- University of Toronto; Toronto Ontario
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Affiliation(s)
- A B Mehta
- University College London School of Medicine, Royal Free Hospital Campus, London, UK
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Augustine EF, Mink JW. Enzyme replacement in neuronal storage disorders in the pediatric population. Curr Treat Options Neurol 2013; 15:634-51. [PMID: 23955157 DOI: 10.1007/s11940-013-0256-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OPINION STATEMENT In the past 15 years, for select lysosomal storage diseases, there has been a shift from symptom management to disease modification in terms of treatment strategy, mainly related to use of enzyme replacement therapy (ERT). Yet the application of ERT is for very few diseases, and while beneficial, ERT does not represent a cure. For some disorders, the advent of ERT has made a dramatic impact, while for others, benefits have been much more modest. Understanding of the long-term effects as well as the appropriate time for initiation of ERT is under exploration in a number of diseases, while the feasibility of ERT is still being established for others. No definite effects of ERT on central nervous system manifestations of lysosomal storage diseases have been observed for any disease to date. New strategies, including intrathecal enzyme replacement, gene therapy and substrate reduction therapy are being developed in animal models and clinical trials, which hopefully will begin a new era of nervous system disease modification in neuronal storage disorders.
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Affiliation(s)
- Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box #631, Rochester, NY, 14642, USA,
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Elstein D, Zimran A. Safety and efficacy of velaglucerase alfa replacement therapy for patients with type 1 Gaucher disease. Expert Rev Endocrinol Metab 2013; 8:333-339. [PMID: 30736148 DOI: 10.1586/17446651.2013.811871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gaucher disease is a multisystem disorder caused by deficiency of β-glucocerebrosidase. Exogenously delivered enzyme replacement therapy (ERT) is currently standard of care. Since 1994, intravenously delivered recombinant ERT with imiglucerase (Cerezyme; Genzyme Corporation, Cambridge, MA, USA) improves hematological, visceral and skeletal features of Gaucher disease at dosages of 15-60 units/kg bodyweight/infusion, administered every other week (EOW). Velaglucerase alfa (VPRIV®; Shire HGT, MA, USA) is a human wild-type-sequenced ERT produced in human cell lines using proprietary Gene-Activation® technology (Shire HGT). This article describes the results of a Phase I/II seminal trial in treatment-naive non-neuronopathic patients (including stepwise dose reduction to 30 units/kg/EOW) and three Phase III trials (two doses: 45 or 60 units/kg/EOW; switch-over from imiglucerase at identical dose; head-to-head with imiglucerase, 60 units/kg/EOW) and Phase III extension trial. Velaglucerase alfa was approved in 2010 in many countries; based on clinical trial experience, it is safe and effective in treatment-naive and switch-over patients, children and adults, splenectomized patients and those with an intact spleen.
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Affiliation(s)
- Deborah Elstein
- b Gaucher Clinic, Shaare Zedek Medical Center, POB 3235, 12 Bayit Street, Jerusalem, 91031, Israel.
| | - Ari Zimran
- a Gaucher Clinic, Shaare Zedek Medical Center, POB 3235, 12 Bayit Street, Jerusalem, 91031, Israel
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