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Leaf RK, Naik H, Jiang PY, Elmariah SB, Hodges P, Mead J, Trinidad J, Saberi B, Tran B, Valiante S, Mernick F, Leaf DE, Anderson KE, Dickey AK. Afamelanotide for Treatment of the Protoporphyrias: Impact on Quality of Life and Laboratory Parameters in a US Cohort. Life (Basel) 2024; 14:689. [PMID: 38929673 PMCID: PMC11204624 DOI: 10.3390/life14060689] [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: 04/28/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are rare disorders of heme biosynthesis characterized by severe cutaneous phototoxicity. Afamelanotide, an α-melanocyte-stimulating hormone analogue, is the only approved treatment for protoporphyria and leads to increased light tolerance and improved quality of life (QoL). However, published experience with afamelanotide in the US is limited. METHODS Here, we report on all adults who received at least one dose of afamelanotide at the Massachusetts General Hospital Porphyria Center from 2021 to 2022. Changes in the time to phototoxic symptom onset, QoL, and laboratory parameters were assessed before and during treatment with afamelanotide. RESULTS A total of 29 patients with protoporphyria were included, 26 of whom (72.2%) received ≥2 afamelanotide implants. Among the patients who received ≥2 implants, the median time to symptom onset following sunlight exposure was 12.5 min (IQR, 5-20) prior to the initiation of afamelanotide and 120 min (IQR, 60-240) after treatment (p < 0.001). Improvements in QoL during afamelanotide treatment were measured using two QoL tools, with good correlation observed between these two instruments. Finally, we found no improvements in the median levels of metal-free erythrocyte protoporphyrin, plasma protoporphyrin, or liver biochemistries during versus prior to the initiation of afamelanotide treatment. CONCLUSIONS This study highlights a dramatic clinical benefit of afamelanotide in relation to light tolerance and QoL in protoporphyria, albeit without improvement in protoporphyrin levels or measures of liver function.
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Affiliation(s)
- Rebecca K. Leaf
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (P.H.); (J.M.)
- Harvard Medical School, Boston, MA 02115, USA; (J.T.); (B.S.); (D.E.L.)
| | - Hetanshi Naik
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Paul Y. Jiang
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (P.Y.J.); (B.T.)
| | - Sarina B. Elmariah
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Dermatology, University California San Francisco, San Francisco, CA 94143, USA
| | - Pamela Hodges
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (P.H.); (J.M.)
| | - Jennifer Mead
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA; (P.H.); (J.M.)
| | - John Trinidad
- Harvard Medical School, Boston, MA 02115, USA; (J.T.); (B.S.); (D.E.L.)
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Behnam Saberi
- Harvard Medical School, Boston, MA 02115, USA; (J.T.); (B.S.); (D.E.L.)
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Benny Tran
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (P.Y.J.); (B.T.)
| | - Sarah Valiante
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA 02114, USA; (S.V.); (F.M.)
| | - Francesca Mernick
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA 02114, USA; (S.V.); (F.M.)
| | - David E. Leaf
- Harvard Medical School, Boston, MA 02115, USA; (J.T.); (B.S.); (D.E.L.)
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Karl E. Anderson
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Amy K. Dickey
- Harvard Medical School, Boston, MA 02115, USA; (J.T.); (B.S.); (D.E.L.)
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (P.Y.J.); (B.T.)
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Mathias SD, Burke L, Colwell HH, Mensing G, Savage W, Naik H. Development and Content Validation of Novel Patient-Reported Outcome Measures to Assess Disease Severity and Change in Patients with Erythropoietic Protoporphyria: The EPP Impact Questionnaire (EPIQ). Patient Relat Outcome Meas 2024; 15:17-30. [PMID: 38375415 PMCID: PMC10875163 DOI: 10.2147/prom.s438892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose Erythropoietic protoporphyria (EPP), a rare inherited disorder, presents in early childhood with severe, painful phototoxicity, with significant impacts on health-related quality of life (HRQoL). Previous studies have not captured all concepts important to patients. Therefore, this study sought to develop a novel, comprehensive, and content valid patient-reported outcome (PRO) measure to assess the efficacy of new therapies. Patients and Methods Qualitative interviews were conducted with EPP participants and clinical experts to obtain views on concepts relevant to patients. Results informed the development of novel PROs, which were debriefed during subsequent combined concept elicitation and cognitive debriefing interviews. Results Twenty-three interviews were conducted with 17 adults and 6 adolescents with EPP. Concept elicitation revealed that participants experienced many symptoms with significant variability. The most common were burning, pain, swelling, and tingling. Tingling was the most common prodromal symptom, while burning was the most bothersome, and pain was the worst full reaction symptom. Participants reported being negatively impacted in their ability to do daily activities, and social and emotional functioning. Many reported impacted ability to work and be productive at their job. Participants reviewed and completed the newly developed PRO measures assessing full reactions and ability to do activities, as well as items to assess severity and change in severity of prodromal symptoms, full reactions, and EPP overall. All measures were found to be comprehensive, clear, and relevant. Conclusion PRO measures are needed to assess important aspects of HRQoL and evaluate therapeutic response. These PRO measures are unique in assessing overall severity and change in EPP.
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Affiliation(s)
| | | | | | | | | | - Hetanshi Naik
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA, USA
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