1
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Elstein D, Belmatoug N, Bembi B, Deegan P, Fernandez-Sasso D, Giraldo P, Göker-Alpan Ö, Hughes D, Lau H, Lukina E, Revel-Vilk S, Schwartz IVD, Istaiti M, Botha J, Gadir N, Schenk J, Zimran A. Twelve Years of the Gaucher Outcomes Survey (GOS): Insights, Achievements, and Lessons Learned from a Global Patient Registry. J Clin Med 2024; 13:3588. [PMID: 38930117 PMCID: PMC11204885 DOI: 10.3390/jcm13123588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/31/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Long-term patient registries are important for evaluating treatment outcomes in patients with rare diseases, and can provide insights into natural disease history and progression in real-world clinical practice. Initiated in 2010, the Gaucher Outcome Survey (GOS) is an ongoing, international, multicenter, observational registry (ClinicalTrials.gov Identifier: NCT03291223) for patients with a diagnosis of Gaucher disease (GD), irrespective of treatment type or status, with a primary objective to monitor safety and long-term effectiveness of velaglucerase alfa. Methods: Here, we evaluated the GOS population 12 years after the registry initiation. Results: As of 25 February 2023, 2084 patients enrolled in the GOS and 1643 received GD-specific treatment. Patients exhibited broad heterogeneity at baseline: age of diagnosis (0 to 85.3 years), hemoglobin concentrations (<80.0 g/L to >150 g/L), platelet counts (<50 × 109/L to >450 × 109/L), and liver and spleen volumes. Most patients treated with enzyme replacement therapy or substrate reduction therapy reported improvements in clinical parameters within 1 year of treatment initiation, maintained over the course of treatment up to 12 years, whereas untreated patients had baseline values closer to standard reference thresholds and showed stability over time. Conclusion: The 12-year data from the GOS confirm the impact of long-term treatment with GD-specific agents and offer insights into disease progression and outcomes in a real-world setting.
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Affiliation(s)
- Deborah Elstein
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (J.B.); (N.G.); (J.S.)
| | - Nadia Belmatoug
- Assistance-Publique Hôpitaux de Paris Nord, Université Paris Cité, 92110 Clichy, France;
| | - Bruno Bembi
- Centre for Lysosomal Diseases, Academic Medical Centre Hospital of Udine, 33100 Udine, Italy;
| | - Patrick Deegan
- Department of Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
| | | | - Pilar Giraldo
- CIBER de Enfermedades Raras, IIS Aragon, 50009 Zaragoza, Spain;
- Translational Research Unit, IIS Aragon, 50009 Zaragoza, Spain
| | - Özlem Göker-Alpan
- Lysosomal Disorders Unit and Center for Clinical Trials, O and O Alpan LLC, Fairfax, VA 22030, USA;
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London NW3 2QG, UK;
| | - Heather Lau
- Langone Medical Cessnter, New York University, New York, NY 10016, USA
| | - Elena Lukina
- Department of Orphan Diseases, National Medical Research Center for Hematology, 125167 Moscow, Russia;
| | - Shoshana Revel-Vilk
- Gaucher Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (S.R.-V.); (M.I.); (A.Z.)
- School of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Ida Vanessa D. Schwartz
- Genetics Department, Federal University of Rio Grande do Sul (UFRGS), Medical Genetics Service—Clinic Hospital of Porto Alegre, Porto Alegre 90010-150, Brazil;
| | - Majdolen Istaiti
- Gaucher Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (S.R.-V.); (M.I.); (A.Z.)
| | - Jaco Botha
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (J.B.); (N.G.); (J.S.)
| | - Noga Gadir
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (J.B.); (N.G.); (J.S.)
| | - Jörn Schenk
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (J.B.); (N.G.); (J.S.)
| | - Ari Zimran
- Gaucher Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (S.R.-V.); (M.I.); (A.Z.)
- School of Medicine, Hebrew University, Jerusalem 9112102, Israel
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2
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Deegan P, Lau H, Elstein D, Fernandez-Sasso D, Giraldo P, Hughes D, Zimran A, Istaiti M, Gadir N, Botha J, Revel-Vilk S. Long-Term Treatment of Gaucher Disease with Velaglucerase Alfa in ERT-Naïve Patients from the Gaucher Outcome Survey (GOS) Registry. J Clin Med 2024; 13:2782. [PMID: 38792324 PMCID: PMC11122485 DOI: 10.3390/jcm13102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Gaucher disease (GD) is a rare, autosomal, recessive condition characterized by hepatosplenomegaly, thrombocytopenia, anemia, and bone abnormalities, often requiring life-long treatment. Velaglucerase alfa has improved hematologic and visceral parameters in clinical trials; however, limited long-term efficacy and safety data are available. Methods: The Gaucher Outcome Survey (GOS), a structured and validated international registry for patients with confirmed GD, provides an opportunity to evaluate long-term data from patients receiving velaglucerase alfa. Results: This analysis included 376 treatment-naïve children and adults with GD enrolled in GOS, including 20 with type 3 GD, who initiated velaglucerase alfa through participation in clinical trials or as part of their clinical management and continued treatment for a mean (range) time of 6.6 (0.003-18.6) years. Initial improvements in hematologic and visceral parameters and the biomarkers glucosylsphingosine (lyso-GL1) and chitotriosidase were observed after one year of treatment and were maintained throughout the follow-up period. Of 129 (34.3%) patients who developed adverse events during the follow-up period, events were considered related to treatment in 33 (8.8%). None led to treatment discontinuation. There were 21 deaths overall, none of which were considered related to treatment. Conclusions: This analysis of data from the GOS registry supports the safety and efficacy of velaglucerase alfa in patients with GD.
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Affiliation(s)
- Patrick Deegan
- Lysosomal Disorders Unit, Cambridge University Hospitals, Hills Road, Cambridge CB2 0QQ, UK
| | - Heather Lau
- Langone Medical Center, New York University, 333 E 33rd St, New York, NY 10016, USA;
| | - Deborah Elstein
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Zurich, Switzerland; (D.E.); (N.G.); (J.B.)
| | | | - Pilar Giraldo
- En el Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, IIS Aragon, C. de San Juan Bosco 13, 50009 Zaragoza, Spain;
- Translational Research Unit, IIS Aragon, Paseo de Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, Pond Street, London NW3 2QG, UK;
| | - Ari Zimran
- Gaucher Unit, Shaare Zedek Medical Center, Shmuel (Hans) Beyth St 12, Jerusalem 9103102, Israel; (A.Z.); (M.I.); (S.R.-V.)
- The Faculty of Medicine, Hebrew University, Campus Ein Kerem, Jerusalem 9112102, Israel
| | - Majdolen Istaiti
- Gaucher Unit, Shaare Zedek Medical Center, Shmuel (Hans) Beyth St 12, Jerusalem 9103102, Israel; (A.Z.); (M.I.); (S.R.-V.)
| | - Noga Gadir
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Zurich, Switzerland; (D.E.); (N.G.); (J.B.)
| | - Jaco Botha
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Zurich, Switzerland; (D.E.); (N.G.); (J.B.)
| | - Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Shmuel (Hans) Beyth St 12, Jerusalem 9103102, Israel; (A.Z.); (M.I.); (S.R.-V.)
- The Faculty of Medicine, Hebrew University, Campus Ein Kerem, Jerusalem 9112102, Israel
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3
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Manisha R, Phadke SR. Long-Term Outcomes of Disease Modifying Therapies in Gaucher Disease. Indian J Pediatr 2024:10.1007/s12098-023-04986-y. [PMID: 38315376 DOI: 10.1007/s12098-023-04986-y] [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] [Received: 05/04/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To study clinical response to treatment with enzyme replacement therapy (ERT) and substrate reduction therapy (SRT) in a cohort of Gaucher disease. METHODS Retrospective data of 8 patients of Gaucher disease was compiled. The treatment included all three currently available enzyme replacement therapies as well as substrate reduction therapy with Eliglustat. The relevant blood investigations were done in follow-up visits. The assessment of the effects of long-term treatment over varying periods up to 13 y was done with various issues related to the course of therapy documented. RESULTS Improvement in hematological parameters was seen in all patients. Reduction of spleen size occurred in 7 of 8 patients (87.5%). One patient had 2 successful pregnancies while on therapy. A distinct patient with type 3 Gaucher disease developed complication in the form of Gaucheroma within the spleen. CONCLUSIONS Awareness about the disease and the efficacy of the therapies amongst pediatricians will help in early diagnosis and better outcomes. The available therapies have changed the outcome of the patients and improved the quality of life in patients with Gaucher disease. The data of Indian patients is important at this juncture when under Rare Disease Policy, government funding has become available for ERT for Gaucher disease patients in India.
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Affiliation(s)
- Rani Manisha
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
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4
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Weinreb NJ. The international cooperative Gaucher group (ICCG) Gaucher registry. Best Pract Res Clin Haematol 2023; 36:101522. [PMID: 38092479 DOI: 10.1016/j.beha.2023.101522] [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: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023]
Abstract
Gaucher disease GD), is a rare lysosomal storage disorder caused by deficient acid β-glucosylceramidase activity and accumulation of glucosylceramide in tissue macrophages. With the 1991 advent of alglucerase enzyme replenishment therapy (ERT), the manufacturer (Genzyme Corporation) created the ICGG Gaucher Registry to collect longitudinal observational "real word" information about GD world-wide in heterogeneous patient populations, to annotate phenotypes and genotypes that define the natural history of GD in untreated patients, and to document and analyze treatment outcomes for alglucerase and any other future treatments. For 32 years, the ICGG Gaucher Registry has functioned as an educational tool for patients, clinicians, and other stakeholders to increase scientific knowledge of GD, to provide practical management guidance, and to positively impact patient care. This paper illustrates how an industry sponsored registry guided by a company independent scientific advisory board has successfully addressed its mission and evolved in step with technologic and scientific advances.
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Affiliation(s)
- Neal J Weinreb
- University Research Foundation for Lysosomal Storage Diseases, 7367 Wexford Terrace, Boca Raton, Florida, USA.
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5
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Giraldo P, Andrade‐Campos M, Morales M. Recommendations on the follow-up of patients with Gaucher disease in Spain: Results from a Delphi survey. JIMD Rep 2023; 64:90-103. [PMID: 36636594 PMCID: PMC9830018 DOI: 10.1002/jmd2.12342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
Management of Gaucher disease (GD) is challenging due to its wide genotypic and phenotypic variability and changing clinical manifestations due to effective treatment. Sixteen face-to-face meetings with experts were held in order to discuss daily clinical practice and identify controversies regarding the management of GD. With this information, a questionnaire with 93 recommendations for different clinical scenarios was designed, and a Delphi survey among 86 physicians with experience in GD was conducted. Consensus was reached on 73 out of the 93 items. Recommendations on follow-up of adult and pediatric patients were in line with current guidelines, and underscored the importance of a patient-tailored approach. For the follow-up of stable patients receiving long-term treatment, consensus was reached on the importance of multidisciplinary care that involves pediatricians, internal medicine, and primary care, specialized radiologists, orthopedic surgeons, and hematologists when required. Degree of pain, use of painkillers and antidepressants, and quality of life should be evaluated at every follow-up visit or at least once per year. In general, a closer follow-up was recommended for untreated patients or patients who underwent a treatment change (every 3 months during the first year) and during pregnancy. For pregnant patients, hemostasis and risk of hemorrhage should be assessed, but no consensus was reached for initiation of treatment in asymptomatic pregnant patients. Lastly, recommendations on how to adapt GD management during a COVID-19 pandemic were collected. This expert consensus may help decision-making during the management of GD in specific clinical scenarios.
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Affiliation(s)
- Pilar Giraldo
- HematologyHospital QuironsaludZaragozaSpain
- Fundación Española para el Estudio y Tratamiento de la Enfermedad de Gaucher (FEETEG)ZaragozaSpain
| | - Marcio Andrade‐Campos
- Fundación Española para el Estudio y Tratamiento de la Enfermedad de Gaucher (FEETEG)ZaragozaSpain
- HematologyInstitut Hospital del Mar d'Investigacions Mèdiques, IMIM‐Parc de Salut MarBarcelonaSpain
| | - Montserrat Morales
- Reference Unit for Inherited Metabolic Disease, Hospital Universitario “12 de Octubre”MadridSpain
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6
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Farahbakhshian S, Inocencio TJ, Poorman G, Wright E, Pathak RR, Bullano M. Re: Response letter to Sanofi's communication related to "the budget impact of enzyme replacement therapy in type 1 Gaucher disease in the United States". J Med Econ 2023; 26:581-583. [PMID: 37068171 DOI: 10.1080/13696998.2023.2197785] [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: 04/19/2023]
Affiliation(s)
| | | | | | - Ekaterina Wright
- US Medical, Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
| | | | - Michael Bullano
- US Medical, Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
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7
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Titievsky L, Schuster T, Wang R, Younus M, Palladino A, Quazi K, Wajnrajch MP, Hernandez B, Becker PS, Weinreb NJ, Chambers C, Mansfield R, Taylor L, Tseng LJ, Kaplan P. Safety and effectiveness of taliglucerase alfa in patients with Gaucher disease: an interim analysis of real-world data from a multinational drug registry (TALIAS). Orphanet J Rare Dis 2022; 17:145. [PMID: 35365177 PMCID: PMC8973565 DOI: 10.1186/s13023-022-02289-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Limited real-world data from routine clinical care are available on the safety and effectiveness of treatment with taliglucerase alfa in patients with Gaucher disease (GD). Methods Taliglucerase Alfa Surveillance (TALIAS), a multinational prospective Drug Registry of patients with GD, was established to evaluate the long-term safety (primary objective) and effectiveness (secondary objective) of taliglucerase alfa. We present an interim analysis of the data from the Drug Registry collected over the 5-year period from September 2013 to January 2019. Results A total of 106 patients with GD (15.1% children aged < 18 years; 53.8% females) treated with taliglucerase alfa have been enrolled in the Drug Registry, as of January 7, 2019. The median duration of follow-up was 795 days with quartiles (Q1, Q3) of 567 and 994 days. Fifty-three patients (50.0%) were from Israel, 28 (26.4%) were from the United States, and 25 (23.6%) were from Albania. At the time of enrollment, most patients (87.7%) had received prior enzyme replacement therapy (ERT). Thirty-nine of the 106 patients had treatment-emergent adverse events (AEs). Twelve of the 106 patients experienced serious AEs; two patients experienced four treatment-related serious AEs. Four patients died, although none of the deaths was considered to be related to taliglucerase alfa treatment by the treating physicians. Nine patients discontinued from the study, including the four who died. At baseline, patients with prior ERT had a higher mean hemoglobin concentration and platelet counts than treatment-naïve patients, likely reflecting the therapeutic effects of prior treatments. During follow-up, the hemoglobin concentration and platelet counts increased in the treatment-naïve patients and remained relatively constant or increased slightly in patients with prior ERT. Spleen and liver volumes decreased in treatment-naïve patients. Conclusions The interim data showed no new or emergent safety signals. The overall interim data are consistent with the clinical program experience and known safety and effectiveness profile of taliglucerase alfa. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02289-7.
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Affiliation(s)
| | | | | | | | | | | | - Michael P Wajnrajch
- Pfizer, Inc., New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | | | - Pamela S Becker
- University of California, Irvine, Irvine, CA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Neal J Weinreb
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | - Paige Kaplan
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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8
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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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9
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Cohen Y, Frydman D, Rotem R, Kofman R, Zimran A, Revel-Vilk S, Grisaru-Granovsky S. Risk of postpartum hemorrhage in multiparous women with Gaucher disease: A call for reconsidering enzyme replacement therapy in all pregnant patients. J Inherit Metab Dis 2021; 44:1165-1173. [PMID: 33829536 DOI: 10.1002/jimd.12382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022]
Abstract
For the last three decades, enzyme replacement therapy (ERT) for Gaucher disease (GD) has been available. We aimed to evaluate the effect of ERT on the pregnancy and obstetric outcome in a unique group of multiparous women with type 1 GD (GD1) who had pregnancies with and without ERT. The Gaucher Unit database (1987-2019) was searched for multiparous women who had pregnancies before and after the institution of ERT. Data were collected from the clinic files and study-specific questionnaires. Descriptive, correlation analysis and generalized estimating equations (GEE) were used to study the effect of ERT and confounding variables on study outcomes. We identified 19 women with 105 pregnancies, among which 26 (24.7%) terminated in first-trimester miscarriage. The risk for miscarriage was associated with the severity of GD1 genotype and phenotype, but not with ERT usage. Early postpartum hemorrhage (PPH) was reported in 16 (84%) women after 25 deliveries (31.6%, 95% CI 21.6%-43.1%). The risks of early PPH and red blood cell (RBC) transfusions were significantly lower when ERT was used during pregnancy, OR (95% CI) 0.13 (0.03-0.54) and 0.27 (0.08-0.94), respectively, compared to pregnancies without the use of ERT. Enzyme replacement therapy during pregnancy is risk reducing for early PPH and RBC transfusions in women with GD1. We suggest considering ERT for the benefit of all pregnant women with GD1, including mild GD1.
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Affiliation(s)
- Yael Cohen
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dafna Frydman
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Roei Kofman
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ari Zimran
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shoshana Revel-Vilk
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
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10
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Grabowski GA, Antommaria AHM, Kolodny EH, Mistry PK. Gaucher disease: Basic and translational science needs for more complete therapy and management. Mol Genet Metab 2021; 132:59-75. [PMID: 33419694 PMCID: PMC8809485 DOI: 10.1016/j.ymgme.2020.12.291] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/15/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Gregory A Grabowski
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati College of Medicine, United States of America; Division of Human Genetics, Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
| | - Armand H M Antommaria
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Lee Ault Carter Chair of Pediatric Ethics, Cincinnati Children's Research Foundation, Cincinnati, OH, United States of America.
| | - Edwin H Kolodny
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States of America.
| | - Pramod K Mistry
- Departments of Medicine and Pediatrics, Yale School of Medicine, New Haven, CT, United States of America.
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11
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Lukina E, Balwani M, Belmatoug N, Watman N, Hughes D, Gaemers SJM, Foster MC, Lewis G, Peterschmitt MJ. Pregnancy outcome in women with Gaucher disease type 1 who had unplanned pregnancies during eliglustat clinical trials. JIMD Rep 2021; 57:76-84. [PMID: 33473343 PMCID: PMC7802626 DOI: 10.1002/jmd2.12172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/12/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022] Open
Abstract
Gaucher disease type 1 (GD1) is an inherited lysosomal storage disorder caused by deficient enzymatic activity of acid β-glucosidase, resulting in accumulation of its substrate glucosylceramide, leading to debilitating visceral, hematologic, and skeletal manifestations. Women with GD1 are at increased risk for complications during pregnancy, delivery, and postpartum. Treatment with enzyme replacement therapy is generally recommended before and during pregnancy to reduce risks. Eliglustat, an oral substrate-reduction therapy, is a first-line treatment for adults with GD1 adults who have extensive, intermediate, or poor CYP2D6-metabolizer phenotypes (>90% of patients). We report on pregnancy outcomes among women in eliglustat trials who had unplanned pregnancies and female partners of men in the trials. In four phase 2 and 3 eliglustat trials of 393 adults with GD1, women of childbearing potential were required to use contraception, have monthly pregnancy tests, and discontinue eliglustat promptly if pregnant. In phase 2 and 3 trials, 18 women had 19 pregnancies, resulting in 14 healthy infants from 13 pregnancies (one set of twins), three elective terminations, one ectopic pregnancy, one spontaneous abortion, and one in utero death. Median estimated eliglustat exposure duration during pregnancy was 38 days. In phase 1 trials (non-GD1 subjects), one woman had a spontaneous abortion. Partners of 16 eliglustat-treated men with GD1 had 18 pregnancies, all resulting in healthy infants. Eliglustat is not approved during pregnancy due to limited data. Guidelines for clinicians and patients with GD that address use of eliglustat in women of childbearing potential are needed.
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Affiliation(s)
- Elena Lukina
- National Research Center for HematologyMoscowRussia
| | | | - Nadia Belmatoug
- Beaujon Hospital, University of Paris, Assistance Publique‐Hopitaux de ParisParisFrance
| | | | - Derralynn Hughes
- Royal Free London NHS Foundation Trust, University College LondonLondonUK
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12
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Abstract
Importance Inherited metabolic disorders, or inborn errors of metabolism, can result in significant morbidity and mortality. Advances in genetic testing, including newborn screening and prenatal carrier screening, continue to increase awareness and highlight the importance of these conditions. Increasingly, women born with these conditions are surviving to adulthood, and many become pregnant. The practicing obstetrician-gynecologist should be familiar with the most common and the most relevant inherited metabolic disorders affecting women. Objective The objective of this review is to define inherited metabolic disorders that have relevance to the obstetrician-gynecologist. We discuss the diagnosis, presentation, epidemiology, and special concerns to the obstetrician-gynecologist managing patients affected by these conditions. Evidence Acquisition A MEDLINE search of "inherited metabolic disorders" and "inborn errors of metabolism" and specific conditions reported in the review was performed. Results The evidence cited in this review includes 8 case reports or case series, 4 text books, 1 systematic review, 1 American College of Obstetricians and Gynecologists committee opinion, and 18 additional peer-reviewed journal articles that were original research or expert opinion summaries. Conclusions and Relevance Inherited metabolic disorders manifest in diverse ways that have clinical implications for the obstetrician-gynecologist. Knowledge of these disorders and their pathophysiology and genetic basis can improve care provided for women affected by this diverse group of conditions. It is critical to assemble a multidisciplinary team of providers to optimize care for patients with inherited metabolic disorders.
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Oliveira Santos M, Evangelista T, Conceição I. Enzyme replacement therapy with alglucosidase alfa in a late-onset Pompe disease patient during pregnancy. Neuromuscul Disord 2018; 28:965-968. [DOI: 10.1016/j.nmd.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/23/2022]
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14
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Torralba-Cabeza MÁ, Olivera-González S, Sierra-Monzón JL. The Importance of a Multidisciplinary Approach in the Management of a Patient with Type I Gaucher Disease. Diseases 2018; 6:diseases6030069. [PMID: 30049986 PMCID: PMC6164989 DOI: 10.3390/diseases6030069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 01/17/2023] Open
Abstract
Managing the multisystemic symptoms of type I Gaucher Disease (GD) requires a multidisciplinary team approach that includes disease-specific treatments, as well as supportive care. This involves a range of medical specialists, general practitioners, supportive care providers, and patients. Phenotype classification and the setting of treatment goals are important for optimizing the management of type I GD, and for providing personalized care. The ability to classify disease severity using validated measurement tools allows the standardization of patient monitoring, and the measurement of disease progression and treatment response. Defining treatment goals is useful to provide a benchmark for assessing treatment response and managing the expectations of patients and their families. Although treatment goals will vary depending on disease severity, they include the stabilization, improvement or reversal (if possible) of clinical manifestations. Enzyme replacement therapy (ERT) is the standard care for patients with type I GD, but a novel substrate reduction therapy (SRT), Eliglustat, has demonstrated safety and efficacy in selected patients. To ensure that treatment goals are being achieved, regular and comprehensive follow up are necessary.
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Affiliation(s)
- Miguel-Ángel Torralba-Cabeza
- Aragon Health Research Institute (ISS Aragón), Department of Internal Medicine, Unit of Rare Disorders, "Lozano Blesa" University Hospital, 15th San Juan Bosco Avenue, 50009 Zaragoza, Spain.
| | - Susana Olivera-González
- Aragon Health Research Institute (ISS Aragón), Department of Internal Medicine, Unit of Rare Disorders, "Lozano Blesa" University Hospital, 15th San Juan Bosco Avenue, 50009 Zaragoza, Spain.
| | - José-Luis Sierra-Monzón
- Aragon Health Research Institute (ISS Aragón), Department of Internal Medicine, Unit of Rare Disorders, "Lozano Blesa" University Hospital, 15th San Juan Bosco Avenue, 50009 Zaragoza, Spain.
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15
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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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16
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Jonker CJ, Kwa MSG, van den Berg HM, Hoes AW, Mol PGM. Drug Registries and Approval of Drugs: Promises, Placebo, or a Real Success? Clin Ther 2018; 40:768-773. [PMID: 29709456 DOI: 10.1016/j.clinthera.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/30/2018] [Accepted: 04/09/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE As part of the approval process, regulatory authorities often require postauthorization studies that involve patient registries; it is unknown, however, whether such registry studies are adequately completed. We investigated whether registry studies for new drugs were performed as agreed at time of approval. METHODS This study reviewed protocols and follow-up reports for 73 registry studies that were proposed for 43 drugs approved by the Committee for Medicinal Products for Human Use in Europe in the period 2007 to 2010. RESULTS The data lock point of January 1, 2016, was taken to allow a 5-year follow-up period for each drug after approval. At that time, 2 studies (3%) in registries had been finalized, 19 registries (26%) had not enrolled any patients, and 52 studies (71%) were ongoing. The median enrollment was 31% (interquartile range [IQR], 6-104) of the required number of patients for 41 registry studies that had a predefined sample size, 30% (IQR, 2-101) for nonimposed registries, and 61% (IQR, 18-144) for imposed registries. IMPLICATIONS Enrollment of patients into postapproval registries is poor, although the results for imposed registries seem better. Currently, registries only have a limited impact on resolving gaps in the knowledge of a drug's benefits and risks at time of marketing authorization.
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Affiliation(s)
- Carla J Jonker
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marcel S G Kwa
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | | | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter G M Mol
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
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17
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Abstract
INTRODUCTION Gaucher disease, the autosomal recessive deficiency of the lysosomal enzyme glucocerebrosidase, is associated with wide phenotypic diversity including non-neuronopathic, acute neuronopathic, and chronic neuronopathic forms. Overlap between types can render definitive diagnoses difficult. However, differentiating between the different phenotypes is essential due to the vast differences in clinical outcomes and response to therapy. Genotypic information is helpful, but cannot always be used to make clinical predictions. Current treatments for Gaucher disease, including enzyme replacement therapy and substrate reduction therapy, can reverse many of the non-neurological manifestations, but these therapies must be administered continually and are extremely costly. AREAS COVERED We reviewed the literature concerning the varied clinical presentations of Gaucher disease throughout the lifetime, along with treatment options, management goals, and current and future research challenges. A PubMed literature search was performed for relevant publications between 1991 to January 2018. EXPERT COMMENTARY Interest and research in the field of Gaucher disease is rapidly expanding. However, significant barriers remain in our ability to predict phenotype, assess disease progression using objective biomarkers, and determine optimal treatment strategy on an individual basis. As the field grows, we anticipate identification of genetic modifiers, new biomarkers, and small-molecule chaperone therapies, which may improve patient quality of life.
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Affiliation(s)
- Sam E Gary
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
| | - Emory Ryan
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
| | - Alta M Steward
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
| | - Ellen Sidransky
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
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18
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Zimran A, Belmatoug N, Bembi B, Deegan P, Elstein D, Fernandez-Sasso D, Giraldo P, Goker-Alpan O, Lau H, Lukina E, Panahloo Z, Schwartz IVD. Demographics and patient characteristics of 1209 patients with Gaucher disease: Descriptive analysis from the Gaucher Outcome Survey (GOS). Am J Hematol 2018; 93:205-212. [PMID: 29090476 PMCID: PMC5814927 DOI: 10.1002/ajh.24957] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 12/24/2022]
Abstract
The Gaucher Outcome Survey (GOS) is an international Gaucher disease (GD) registry established in 2010 for patients with a confirmed GD diagnosis, regardless of GD type or treatment status, designed to evaluate the safety and long‐term effectiveness of velaglucerase alfa and other GD‐related treatments. As of February 25, 2017, 1209 patients had enrolled, the majority from Israel (44.3%) and the US (31.4%). Median age at GOS entry was 40.4 years, 44.1% were male, and 13.3% had undergone a total splenectomy. Most patients had type 1 GD (91.5%) and were of Ashkenazi Jewish ethnicity (55.8%). N370S/N370S was the most prevalent genotype, accounting for 44.2% of genotype‐confirmed individuals (n = 847); however, there was considerable variation between countries. A total of 887 (73.4%) patients had received ≥1 GD‐specific treatment at any time, most commonly imiglucerase (n = 587), velaglucerase alfa (n = 507), and alglucerase (n = 102). Hematological and visceral findings at the time of GOS entry were close to normal for most patients, probably a result of previous treatment; however, spleen volume of patients in Israel was almost double that of patients elsewhere (7.2 multiples of normal [MN] vs. 2.7, 2.9 and 4.9 MN in the US, UK and rest of world), which may be explained by a greater disease severity in this cohort. This analysis aimed to provide an overview of GOS and present baseline demographic and disease characteristics of participating patients to help improve the understanding of the natural history of GD and inform the overall management of patients with the disease.
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Affiliation(s)
- Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School; Jerusalem Israel
| | - Nadia Belmatoug
- Centre de Référence des Maladies Lysosomales; Hôpitaux universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service de Médecine Interne; Clichy France
| | - Bruno Bembi
- Regional Coordinator Centre for Rare Diseases; University Hospital “Santa Maria della Misericordia”; Udine Italy
| | - Patrick Deegan
- Department of Medicine; University of Cambridge and Lysosomal Disorders Unit; Cambridge UK
| | | | | | - Pilar Giraldo
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto Salud Carlos III; Zaragoza Spain
- Translational Research Unit, Aragon Institute of Health Research (IISAragon); Zaragoza Spain
- Spanish Foundation for the Study and Therapy of Gaucher Disease (FEETEG); Zaragoza Spain
- Unidad de Investigación Traslacional, Pta Baja, Hospital Universitario Miguel Servet; Zaragoza Spain
| | - Ozlem Goker-Alpan
- Lysosomal Disorders Unit and Center for Clinical Trials, O&O Alpan, LLC; Fairfax VA USA
| | - Heather Lau
- New York University Langone Medical Center; New York NY USA
| | - Elena Lukina
- Department of Orphan Diseases; National Research Center for Hematology; Moscow Russia
| | | | - Ida Vanessa D. Schwartz
- Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Department of Genetics; Universidade Federal do Rio Grande do Sul; Brazil
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Schwartz IVD, Göker-Alpan Ö, Kishnani PS, Zimran A, Renault L, Panahloo Z, Deegan P. Characteristics of 26 patients with type 3 Gaucher disease: A descriptive analysis from the Gaucher Outcome Survey. Mol Genet Metab Rep 2017; 14:73-79. [PMID: 29326879 PMCID: PMC5758841 DOI: 10.1016/j.ymgmr.2017.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/30/2017] [Indexed: 12/24/2022] Open
Abstract
The Gaucher Outcome Survey (GOS) is an international disease-specific registry established in 2010 for patients with a confirmed diagnosis of Gaucher disease (GD), regardless of GD type or treatment status. Historically, there has been a limited understanding of type 3 GD (GD3) and its natural history in patients irrespective of their treatment status. Here, we describe the disease characteristics of patients with GD3 enrolled in GOS. As of October 2015, 1002 patients had been enrolled, 26 of whom were reported as GD3. The majority of patients with GD3 were from the US (13; 50.0%), seven (26.9%) were from the UK, three (11.5%) from Israel, and three (11.5%) from Brazil. No patients were of Ashkenazi Jewish origin. Median age of symptom onset was 1.4 (interquartile range: 0.5–2.0) years. The most common GBA1 mutation genotype was L444P/L444P, occurring in 16 (69.6%) of 23 patients who had genotyping information available. Nine patients reported a family history of GD (any type). Of 21 patients with treatment status information, 20 (95.2%) had received GD-specific treatment at any time, primarily imiglucerase (14 patients) and/or velaglucerase alfa (13 patients). Hemoglobin concentrations and platelet counts at GOS entry were within normal ranges for most patients, and there were no reports of severe hepatomegaly or of splenomegaly in non-splenectomized patients, most likely indicative of the effects of treatment received prior to GOS entry. This analysis provides information on the characteristics of patients with GD3 that could be used as the baseline for longitudinal follow-up of these patients.
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Affiliation(s)
- Ida Vanessa D Schwartz
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Özlem Göker-Alpan
- Lysosomal Disorders Unit, Center for Clinical Trials, O&O Alpan, LLC, Fairfax, VA, USA
| | | | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, Hadassah Medical School, Hebrew University, Jerusalem, Israel
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