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Schoser B, van der Beek NAME, Broomfield A, Brusse E, Diaz‐Manera J, Hahn A, Hundsberger T, Kornblum C, Kruijshaar M, Laforet P, Mengel E, Mongini T, Orlikowski D, Parenti G, Pijnappel WWMP, Roberts M, Scherer T, Toscano A, Vissing J, van den Hout JMP, van Doorn PA, Wenninger S, van der Ploeg AT. Start, switch and stop (triple-S) criteria for enzyme replacement therapy of late-onset Pompe disease: European Pompe Consortium recommendation update 2024. Eur J Neurol 2024; 31:e16383. [PMID: 38873957 PMCID: PMC11295151 DOI: 10.1111/ene.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/16/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND PURPOSE Two novel enzyme replacement therapies (ERTs), studied in phase 3 trials in late-onset Pompe patients, reached marketing authorization by the European Medicines Agency in 2022 and 2023. The European Pompe Consortium (EPOC) updates and extends the scope of the 2017 recommendations for starting, switching and stopping ERT. METHODS The European Pompe Consortium consists of 25 neuromuscular and metabolic experts from eight European countries. This update was performed after an in-person meeting, three rounds of discussion and voting to provide a consensus recommendation. RESULTS The patient should be symptomatic, that is, should have skeletal muscle weakness or respiratory muscle involvement. Muscle magnetic resonance imaging findings showing substantial fat replacement can support the decision to start in a patient-by-patient scenario. Limited evidence supports switching ERT if there is no indication that skeletal muscle and/or respiratory function have stabilized or improved during standard ERT of 12 months or after severe infusion-associated reactions. Switching of ERT should be discussed on a patient-by-patient shared-decision basis. If there are severe, unmanageable infusion-associated reactions and no stabilization in skeletal muscle function during the first 2 years after starting or switching treatment, stopping ERT should be considered. After stopping ERT for inefficacy, restarting ERT can be considered. Six-monthly European Pompe Consortium muscle function assessments are recommended. CONCLUSIONS The triple-S criteria on ERT start, switch and stop include muscle magnetic resonance imaging as a supportive finding and the potential option of home infusion therapy. Six-monthly long-term monitoring of muscle function is highly recommended to cover insights into the patient's trajectory under ERT.
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Affiliation(s)
- Benedikt Schoser
- Department of Neurology, Friedrich‐Baur‐InstituteLMU Clinics MunichMunichGermany
| | - Nadine A. M. E. van der Beek
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | | | - Esther Brusse
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Jordi Diaz‐Manera
- John Walton Muscular Dystrophy Research CenterNewcastle University Translational and Clinical Research InstituteNewcastle Upon TyneUK
| | - Andreas Hahn
- Department of Child NeurologyJustus‐Liebig‐University GiessenGiessenGermany
| | | | - Cornelia Kornblum
- Neuromuscular Diseases Section, Department of NeurologyUniversity Hospital BonnBonnGermany
| | - Michelle Kruijshaar
- Center for Lysosomal and Metabolic Diseases Center for Lysosomal and Metabolic DiseasesErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Pascal Laforet
- Neurology Department, Raymond Poincaré Hospital, Nord‐Est‐Ile‐de‐France Neuromuscular Reference Center, GarchesAPHPParisFrance
- FHU PHENIX, Université Versailles Saint Quentin en YvelinesParis‐Saclay UniversityParisFrance
| | - Eugen Mengel
- Institute of Clinical Science in LSD, SphinCSHochheimGermany
| | - Tiziana Mongini
- Neuromuscular Unit, Department of Neurosciences RLMUniversity of TorinoTorinoItaly
| | - David Orlikowski
- Clinical Investigation Center 1429 APHP/INSERM, UMR 1179, Hôpital Raymond PoincaréUniversité de Versailles Saint Quentin/Paris Saclay, FHU PHENIXParisFrance
| | - Giancarlo Parenti
- Department of Translational MedicineFederico II UniversityNaplesItaly
| | - W. W. M. Pim Pijnappel
- Department of Clinical Genetics, Department of Pediatrics, Center for Lysosomal and Metabolic DiseasesErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Mark Roberts
- Manchester Centre for Clinical NeurosciencesManchesterUK
| | - Thomas Scherer
- Division of Endocrinology, Innere IIIMedical University of ViennaViennaAustria
| | - Antonio Toscano
- ERN‐NMD Center of Messina for Rare Neuromuscular Disorders, Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - John Vissing
- Copenhagen Neuromuscular Center, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Johanna M. P. van den Hout
- Department of Pediatrics, Center for Lysosomal and Metabolic DiseasesErasmus MC, University Medical CenterRotterdamThe Netherlands
| | - Pieter A. van Doorn
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Stephan Wenninger
- Department of Neurology, Friedrich‐Baur‐InstituteLMU Clinics MunichMunichGermany
| | - Ans T. van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic DiseasesErasmus MC, University Medical CenterRotterdamThe Netherlands
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Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines. BMC Pregnancy Childbirth 2022; 22:355. [PMID: 35461218 PMCID: PMC9034550 DOI: 10.1186/s12884-022-04584-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of this study was to investigate guidelines on preterm birth, analyze decision-criteria, and to identify consensus and discrepancies among these guidelines. Design Objective consensus analysis of guidelines. Sample Ten international guidelines on preterm birth. Methods Relevant decision criteria were singleton vs. twin pregnancy, history, cervical length, and cervical surgery / trauma or Mullerian anomaly. Eight treatment recommendations were extracted. For each decision-making criteria the most commonly recommended treatment was identified, and the level of consensus was evaluated. Main outcome measures Consensus and Discrepancies among recommendations. Results In a case of singleton pregnancies with no history of preterm birth and shortened cervix, most guidelines recommend progesterone. In singleton pregnancies with a positive history and shortened cervix, all guidelines recommend a cerclage as an option, alternative or conjunct to progesterone. The majority of the guidelines advise against treatment in twin pregnancies. Conclusions A shortened cervix and a history of preterm birth are relevant in singleton pregnancies. In twins, most guidelines recommend no active treatment. Tweetable abstract Among international guidelines a shortened cervix and a history of preterm birth are relevant in singleton pregnancies. With no history of preterm birth and with a shortened cervix most guidelines recommend progesterone treatment.
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Glatzer M, Leskow P, Caparrotti F, Elicin O, Furrer M, Gambazzi F, Dutly A, Gelpke H, Guckenberger M, Heuberger J, Inderbitzi R, Cafarotti S, Karenovics W, Kestenholz P, Kocher GJ, Kraxner P, Krueger T, Martucci F, Oehler C, Ozsahin M, Papachristofilou A, Wagnetz D, Zaugg K, Zwahlen D, Opitz I, Putora PM. Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists. Transl Lung Cancer Res 2021; 10:1960-1968. [PMID: 34012806 PMCID: PMC8107728 DOI: 10.21037/tlcr-20-1210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Stage III N2 non-small cell lung cancer (NSCLC) is a very heterogeneous disease associated with a poor prognosis. A number of therapeutic options are available for patients with Stage III N2 NSCLC, including surgery [with neoadjuvant or adjuvant chemotherapy (CTx)/neoadjuvant chemoradiotherapy (CRT)] or CRT potentially followed by adjuvant immunotherapy. We have no clear evidence demonstrating a significant survival benefit for either of these approaches, the selection between treatments is not always straightforward and can come down to physician and patient preference. The very heterogeneous definition of resectability of N2 disease makes the decision-making process even more complex. Methods We evaluated the treatment strategies for preoperatively diagnosed stage III cN2 NSCLC among Swiss thoracic surgeons and radiation oncologists. Treatment strategies were converted into decision trees and analysed for consensus and discrepancies. We analysed factors relevant to decision-making within these recommendations. Results For resectable “non-bulky” mediastinal lymph node involvement, there was a trend towards surgery. Numerous participants recommend a surgical approach outside existing guidelines as long as the disease was resectable, even in multilevel N2. With increasing extent of mediastinal nodal disease, multimodal treatment based on radiotherapy was more common. Conclusions Both, surgery- or radiotherapy-based treatment regimens are feasible options in the management of Stage III N2 NSCLC. The different opinions reflected in the results of this manuscript reinforce the importance of a multidisciplinary setting and the importance of shared decision-making with the patient.
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Affiliation(s)
- Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pawel Leskow
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Markus Furrer
- Department of Vascular and Thoracic Surgery, Kantonsspital Chur, Chur, Switzerland
| | - Franco Gambazzi
- Department of Thoracic Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - André Dutly
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Gelpke
- Department of Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jürg Heuberger
- Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Peter Kestenholz
- Department of Thoracic Surgery, Kantonsspital Luzern, Luzern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Kraxner
- Department of Radiation Oncology, Kantonsspital Luzern, Luzern, Switzerland.,Department of Radiation Oncology, Kantonsspital Chur, Chur, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland
| | - Christoph Oehler
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Dirk Wagnetz
- Department of Visceral-Vascular and Thoracic Surgery, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
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Puri RD, Setia N, N V, Jagadeesh S, Nampoothiri S, Gupta N, Muranjan M, Bhat M, Girisha KM, Kabra M, Verma J, Thomas DC, Biji I, Raja J, Makkar R, Verma IC, Kishnani PS. Late onset Pompe Disease in India - Beyond the Caucasian phenotype. Neuromuscul Disord 2021; 31:431-441. [PMID: 33741225 DOI: 10.1016/j.nmd.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 01/14/2023]
Abstract
We evaluated the clinical histories, motor and pulmonary functions, cardiac phenotypes and GAA genotypes of an Indian cohort of twenty patients with late onset Pompe disease (LOPD) in this multi-centre study. A mean age at onset of symptoms and diagnosis of 9.9 ± 9.7 years and 15.8 ± 12.1 years respectively was identified. All patients had lower extremity limb-girdle muscle weakness. Seven required ventilatory support and seven used mobility assists. Of the four who used both assists, two received ventilatory support prior to wheelchair use. Cardiac involvement was seen in eight patients with various combinations of left ventricular hypertrophy, tricuspid regurgitation, cardiomyopathy, dilated ventricles with biventricular dysfunction and aortic regurgitation. Amongst 20 biochemically diagnosed patients (low residual GAA enzyme activity) GAA genotypes of 19 patients identified homozygous variants in eight and compound heterozygous in 11: 27 missense, 3 nonsense, 2 initiator codon, 3 splice site and one deletion. Nine variants in 7 patients were novel. The leaky Caucasian, splice site LOPD variant, c.-32-13T>G mutation was absent. This first study from India provides an insight into a more severe LOPD phenotype with earlier disease onset at 9.9 years compared to 33.3 years in Caucasian patients, and cardiac involvement more than previously reported. The need for improvement in awareness and diagnosis of LOPD in India is highlighted.
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Affiliation(s)
- Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.
| | - Nitika Setia
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinu N
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Sujatha Jagadeesh
- Department of Clinical Genetics & Genetic Counselling, Mediscan Systems, Chennai, India
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences, Kerala, India
| | - Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Muranjan
- Department of Pediatrics, King Edward Memorial Hospital, Mumbai, India
| | - Meenakshi Bhat
- Department of Clinical Genetics, Centre for Human Genetics, Bangalore, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Madhulika Kabra
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Divya C Thomas
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ishpreet Biji
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayarekha Raja
- Department of Clinical Genetics & Genetic Counselling, Mediscan Systems, Chennai, India
| | | | - Ishwar C Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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Abstract
Glycogen storage disease type II (also known as Pompe disease (PD)) is an autosomal recessive disorder caused by defects in α-glucosidase (AαGlu), resulting in lysosomal glycogen accumulation in skeletal and heart muscles. Accumulation and tissue damage rates depend on residual enzyme activity. Enzyme replacement therapy (ERT) should be started before symptoms are apparent in order to achieve optimal outcomes. Early initiation of ERT in infantile-onset PD improves survival, reduces the need for ventilation, results in earlier independent walking, and enhances patient quality of life. Newborn screening (NBS) is the optimal approach for early diagnosis and treatment of PD. In NBS for PD, measurement of AαGlu enzyme activity in dried blood spots (DBSs) is conducted using fluorometry, tandem mass spectrometry, or digital microfluidic fluorometry. The presence of pseudodeficiency alleles, which are frequent in Asian populations, interferes with NBS for PD, and current NBS systems cannot discriminate between pseudodeficiency and cases with PD or potential PD. The combination of GAA gene analysis with NBS is essential for definitive diagnoses of PD. In this review, we introduce our experiences and discuss NBS programs for PD implemented in various countries.
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Putora PM, Leskow P, McDonald F, Batchelor T, Evison M. International guidelines on stage III N2 nonsmall cell lung cancer: surgery or radiotherapy? ERJ Open Res 2020; 6:00159-2019. [PMID: 32083114 PMCID: PMC7024765 DOI: 10.1183/23120541.00159-2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Stage III N2 nonsmall cell lung cancer (NSCLC) is a complex disease with poor treatment outcomes. For patients in whom the disease is considered technically resectable, the main treatment options include surgery (with neoadjuvant or adjuvant chemotherapy/neoadjuvant chemoradiotherapy (CRT)) or CRT followed by adjuvant immunotherapy (dependent on programmed death ligand 1 status). As there is no clear evidence demonstrating a survival benefit between these options, patient preference plays an important role. A lack of a consensus definition of resectability of N2 disease adds to the complexity of the decision-making process. We compared 10 international guidelines on the treatment of NSCLC to investigate the recommendations on preoperatively diagnosed stage III N2 NSCLC. This comparison simplified the treatment paths to multimodal therapy based on surgery or radiotherapy (RT). We analysed factors relevant to decision-making within these guidelines. Overall, for nonbulky mediastinal lymph node involvement there was no clear preference between surgery and CRT. With increasing extent of mediastinal nodal disease, a tendency towards multimodal treatment based on RT was identified. In multiple scenarios, surgery or RT-based treatments are feasible and patient involvement in decision-making is critical. For many patients with stage III N2 NSCLC, radiotherapy or surgery are options and should be discussed with the patienthttp://bit.ly/2Z39MW5
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Affiliation(s)
- Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.,Dept of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Pawel Leskow
- Dept of Thoracic Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Fiona McDonald
- Dept of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Tim Batchelor
- Dept of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Matthiew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Variations in radioiodine ablation: decision-making after total thyroidectomy. Eur J Nucl Med Mol Imaging 2019; 47:554-560. [PMID: 31707428 DOI: 10.1007/s00259-019-04557-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND The role of radioiodine treatment following total thyroidectomy for differentiated thyroid cancer is changing. The last major revision of the American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer in 2015 changed treatment recommendations dramatically in comparison with the European Association of Nuclear Medicine (EANM) 2008 guidelines. We hypothesised that there is marked variability between the different treatment regimens used today. METHODS We analysed decision-making in all Swiss hospitals offering radioiodine treatment to map current practice within the community and identify consensus and discrepancies. RESULTS AND CONCLUSION: We demonstrated that for low-risk DTC patients after thyroidectomy, some institutions offered only follow-up, while RIT with significant activities is recommended in others. For intermediate- and high-risk patients, radioiodine treatment is generally recommended. Dosing and treatment preparation (recombinant human thyroid stimulation hormone (rhTSH) vs. thyroid hormone withdrawal (THW)) vary significantly among centres.
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