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Toscano A, Musumeci O, Sacchini M, Ravaglia S, Siciliano G, Fiumara A, Verrecchia E, Maione M, Gentile J, Fischetto R, Crescimanno G, Taurisano R, Sechi A, Gasperini S, Cianci V, Maggi L, Parini R, Lupica A, Scarpa M. Safety outcomes and patients' preferences for home-based intravenous enzyme replacement therapy (ERT) in pompe disease and mucopolysaccharidosis type I (MPS I) disorder: COVID-19 and beyond. Orphanet J Rare Dis 2023; 18:338. [PMID: 37891668 PMCID: PMC10604412 DOI: 10.1186/s13023-023-02919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The Italian Medicines Agency (AIFA) demands precise information on benefit/risk profile of home-based enzyme replacement therapy (ERT) for the treatment of patients with Pompe disease and Mucopolysaccharidosis type I (MPS I). This passage is necessary to obtain the authorization for ERT home therapy, even after the coronavirus disease-19 (COVID-19) pandemic period. This research intends to evaluate the safety, treatment satisfaction, and compliance of MPS I patients treated with laronidase (Aldurazyme®) and Pompe Disease patients treated with alglucosidase alfa (Myozyme®) in a homecare setting. RESULTS We report herein an early interim analysis of the HomERT (Home infusions of ERT) study, a multicenter, non-interventional, double-cohort study that retrospectively analyzed 38 patients from 14 sites in Italy: cohort A (Pompe disease - 32 patients) and cohort B (MPS I - 6 patients). Among the selected patients who started home therapy before enrollment, the average number of missed home-based infusions was 0.7 (1.3) in cohort A and 3.8 (6.4) in cohort B with no return to the hospital setting. Irrespective of the treatment location, 3 prior ADRs per cohort were reported. The majority of patients preferred home-based infusions (cohort A: 96.9%; cohort B: 100%): the main reason was attributed to treatment convenience (cohort A: 81.3%; cohort B: 83.3%). Despite the underlying conditions, most patients self-evaluated their health as "good" (cohort A: 50%; cohort B: 83.3%). CONCLUSIONS Evidence of favorable safety profile, improved treatment compliance and personal satisfaction validates the use of ERT with laronidase and alglucosidase alfa as a strong candidate for home therapy.
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Affiliation(s)
- Antonio Toscano
- Full Professor of Neurology, ERN-NMD Center of Messina for Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Via Consolare Valeria, 1, Messina, 98125, Italy.
| | - Olimpia Musumeci
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, 98125, ME, Italy
| | - Michele Sacchini
- DH Hereditary metabolic-muscular diseases Meyer Hospital, Ground floor - DH Viale Pieraccini, 24, Florence, 50139, Italy
| | - Sabrina Ravaglia
- IRCCS Fondazione Istituto Neurologico Nazionale C.Mondino, Via Mondino, 2, Pavia, 27100, PV, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, S. Chiara Hospital - University of Pisa, Via Roma, 67, Pisa, 56126, Italy
| | - Agata Fiumara
- A.O.U. Policlinico - Pediatric Clinic and Regional Referral Center for Inherited Metabolic Diseases, Via Santa Sofia, 78, Catania, 95122, CT, Italy
| | - Elena Verrecchia
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Agostino Gemelli University Hospital Foundation, Via Giuseppe Moscati, 31, Rome, 00168, RM, Italy
| | - Melania Maione
- Medical Manager Pompe Disease - Rare Diseases Specialty Care, Sanofi S.r.l., Viale Luigi Bodio 37/b, Milano, 20158, MI, Italy
| | - Jennifer Gentile
- Medical Manager Gaucher, MPS & ASMD, Sanofi S.r.l., Viale Luigi Bodio 37/b, Milano, 20158, MI, Italy
| | - Rita Fischetto
- Policlinico di Bari Stabilimento Pediatrico Giovanni XXIII, Metabolic and Genetic Diseases, Piazza Giulio Cesare, 11, Bari, 70120, BA, Italy
| | - Grazia Crescimanno
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Via La Malfa 153, Palermo, Italy
| | - Roberta Taurisano
- Bambin Gesù Pediatric Hospital Piazza Sant'Onofrio, Rome (RM), 4 00165, Italy
| | - Annalisa Sechi
- Regional Coordination Center for Rare Diseases, Udine University Hospital, Udine, 33100, UD, Italy
| | - Serena Gasperini
- Unit of Inherited Metabolic Disorders, Pediatric Department, IRCCS San Gerardo Foundation dei Tintori, Via Pergolesi, 33 - Monza (MB), Tintori, Italy
| | - Vittoria Cianci
- Great Metropolitan Hospital "Bianchi Melacrino Morelli" - Neurology, Reggio Calabria (RC), Via Melacrino, Calabria, 89100, Italy
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Istituto Neurologico Besta, Via Celoria, 11, Milan, 20133, MI, Italy
| | - Rossella Parini
- ASST Monza - Rare Disease Center, San Gerardo hospital in Monza, Via Pergolesi, Monza, 33 - 20900, MB, Italy
| | - Antonino Lupica
- AOU Policlinico P. Giaccone of Palermo, Via del Vespro 129, Palermo, 90127, Italy
| | - Maurizio Scarpa
- Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, 33100, Italy
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Hughes DA, Aguiar P, Deegan PB, Ezgu F, Frustaci A, Lidove O, Linhart A, Lubanda JC, Moon JC, Nicholls K, Niu DM, Nowak A, Ramaswami U, Reisin R, Rozenfeld P, Schiffmann R, Svarstad E, Thomas M, Torra R, Vujkovac B, Warnock DG, West ML, Johnson J, Rolfe MJ, Feriozzi S. Early indicators of disease progression in Fabry disease that may indicate the need for disease-specific treatment initiation: findings from the opinion-based PREDICT-FD modified Delphi consensus initiative. BMJ Open 2020; 10:e035182. [PMID: 33039984 PMCID: PMC7549469 DOI: 10.1136/bmjopen-2019-035182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease (PREDICT-FD) initiative aimed to reach consensus among a panel of global experts on early indicators of disease progression that may justify FD-specific treatment initiation. DESIGN AND SETTING Anonymous feedback from panellists via online questionnaires was analysed using a modified Delphi consensus technique. Questionnaires and data were managed by an independent administrator directed by two non-voting cochairs. First, possible early indicators of renal, cardiac and central/peripheral nervous system (CNS/PNS) damage, and other disease and patient-reported indicators assessable in routine clinical practice were compiled by the cochairs and administrator from panellists' free-text responses. Second, the panel scored indicators for importance (5-point scale: 1=not important; 5=extremely important); indicators scoring ≥3 among >75% of panellists were then rated for agreement (5-point scale: 1=strongly disagree; 5=strongly agree). Indicators awarded an agreement score ≥4 by >67% of panellists achieved consensus. Finally, any panel-proposed refinements to consensus indicator definitions were adopted if >75% of panellists agreed. RESULTS A panel of 21 expert clinicians from 15 countries provided information from which 83 possible current indicators of damage (kidney, 15; cardiac, 15; CNS/PNS, 13; other, 16; patient reported, 24) were compiled. Of 45 indicators meeting the importance criteria, consensus was reached for 29 and consolidated as 27 indicators (kidney, 6; cardiac, 10; CNS/PNS, 2; other, 6; patient reported, 3) including: (kidney) elevated albumin:creatinine ratio, histological damage, microalbuminuria; (cardiac) markers of early systolic/diastolic dysfunction, elevated serum cardiac troponin; (CNS/PNS) neuropathic pain, gastrointestinal symptoms suggestive of gastrointestinal neuropathy; (other) pain in extremities/neuropathy, angiokeratoma; (patient-reported) febrile crises, progression of symptoms/signs. Panellists revised and approved proposed chronologies of when the consensus indicators manifest. The panel response rate was >95% at all stages. CONCLUSIONS PREDICT-FD captured global opinion regarding current clinical indicators that could prompt FD-specific treatment initiation earlier than is currently practised.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
- Department of Haematology, University College London, London, UK
| | - Patricio Aguiar
- Inborn Errors of Metabolism Reference Center, North Lisbon Hospital Center, Lisbon, Portugal
- Medicine Department, University of Lisbon, Lisbon, Portugal
| | - Patrick B Deegan
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Fatih Ezgu
- Department and Laboratory of Paediatric Metabolic Disorders, Gazi University, Ankara, Turkey
| | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anesthesiologic Sciences, University of Rome La Sapienza, Rome, Italy
| | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
| | - Aleš Linhart
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jean-Claude Lubanda
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - James C Moon
- Cardiac Imaging Department, Barts Heart Centre, London, UK
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland
| | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
| | - Ricardo Reisin
- Department of Neurology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paula Rozenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos, UNLP - CONICET, La Plata, Argentina
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas, USA
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roser Torra
- Inherited Renal Diseases Unit, Autonomous University of Barcelona, Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael L West
- Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jack Johnson
- Fabry Support & Information Group, Concordia, Missouri, USA
- Fabry International Network, Beveren, Belgium
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Brunelli MV, Rabhansl MM, Delacre C, Dankert MM, Cuevillas MV, Frias CT. Home-Based Care for Patients with Lysosomal Storage Disease: Experiences in Argentina. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2019. [DOI: 10.1590/2326-4594-jiems-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Finnigan N, Roberts J, Mercer J, Jones SA. Home infusion with Elosulfase alpha (Vimizim R) in a UK Paediatric setting. Mol Genet Metab Rep 2017; 14:15-18. [PMID: 29159073 PMCID: PMC5675729 DOI: 10.1016/j.ymgmr.2017.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Abstract
Enzyme replacement therapy is the only available treatment for Mucopolysaccharidosis type IVA (MPS IVA, Morquio syndrome). The treatment is lengthy and invasive involving weekly intravenous infusions of 4-5 h. This can cause significant disruption to normal family life so the provision of a safe and effective homecare service is essential. In order to deliver a safe service, robust standards must be in place; this includes appropriately trained members of homecare staff, detailed management for infusion related reactions (IRR) and appropriate venous access. In this report we demonstrate the criteria required to ensure a successful home treatment programme and describe our experience thus far.
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Affiliation(s)
- Niamh Finnigan
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, UK
| | - Jane Roberts
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, UK
| | - Jean Mercer
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, UK
| | - Simon A Jones
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, UK
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Whiteman DA, Kimura A. Development of idursulfase therapy for mucopolysaccharidosis type II (Hunter syndrome): the past, the present and the future. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2467-2480. [PMID: 28860717 PMCID: PMC5574592 DOI: 10.2147/dddt.s139601] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Mucopolysaccharidosis type II (MPS II; Hunter syndrome; OMIM 309900) is a rare, multisystemic, progressive lysosomal storage disease caused by deficient activity of the iduronate-2-sulfatase (I2S) enzyme. Accumulation of the glycosaminoglycans dermatan sulfate and heparan sulfate results in a broad range of disease manifestations that are highly variable in presentation and severity; notably, approximately two-thirds of individuals are affected by progressive central nervous system involvement. Historically, management of this disease was palliative; however, during the 1990s, I2S was purified to homogeneity for the first time, leading to cloning of the corresponding gene and offering a means of addressing the underlying cause of MPS II using enzyme replacement therapy (ERT). Recombinant I2S (idursulfase) was produced for ERT using a human cell line and was shown to be indistinguishable from endogenous I2S. Preclinical studies utilizing the intravenous route of administration provided valuable insights that informed the design of the subsequent clinical studies. The pivotal Phase II/III clinical trial of intravenous idursulfase (Elaprase®; Shire, Lexington, MA, USA) demonstrated improvements in a range of clinical parameters; based on these findings, intravenous idursulfase was approved for use in patients with MPS II in the USA in 2006 and in Europe and Japan in 2007. Evidence gained from post-approval programs has helped to improve our knowledge and understanding of management of patients with the disease; as a result, idursulfase is now available to young pediatric patients, and in some countries patients have the option to receive their infusions at home. Although ERT with idursulfase has been shown to improve somatic signs and symptoms of MPS II, the drug does not cross the blood–brain barrier and so treatment of neurological aspects of the disease remains challenging. A number of novel approaches are being investigated, and these may help to improve the care of patients with MPS II in the future.
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Affiliation(s)
- David Ah Whiteman
- Research & Development, Shire Human Genetic Therapies, Inc., Lexington, MA, USA
| | - Alan Kimura
- Research & Development, Shire Human Genetic Therapies, Inc., Lexington, MA, USA
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Concolino D, Amico L, Cappellini M, Cassinerio E, Conti M, Donati M, Falvo F, Fiumara A, Maccarone M, Manna R, Matucci A, Musumeci M, Nicoletti A, Nisticò R, Papadia F, Parini R, Peluso D, Pensabene L, Pisani A, Pistone G, Rigoldi M, Romani I, Tenuta M, Torti G, Veroux M, Zachara E. Home infusion program with enzyme replacement therapy for Fabry disease: The experience of a large Italian collaborative group. Mol Genet Metab Rep 2017; 12:85-91. [PMID: 28702361 PMCID: PMC5484973 DOI: 10.1016/j.ymgmr.2017.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022] Open
Abstract
Fabry disease (FD) [OMIM 301500] is an X-linked lysosomal storage disorder caused by a deficiency of the lysosomal enzyme alpha-galactosidase A, resulting in progressive multisystem accumulation of globotriaosylceramide (Gb3). Although the introduction of Enzyme Replacement Therapy (ERT) resulted in a variety of clinical benefits, life-long intravenous (IV) treatment with ERT with an every other week schedule, may interfere with daily life activities and impact on QoL. We report here a multicentric, observational, longitudinal data analysis on a large cohort of 85 Italian FD patients (45 males, 40 females) from 11 out of 20 Italian regions, who received a cumulative number of 4269 home infusions of agalsidase alfa. For the whole cohort, the average duration of home therapy was 1 year and 11 months (range 3 months–4 years and 6 months), and during this period, compliance to treatment (number of infusions performed vs scheduled) reached 100%. The EQ-5 VAS scale was administered to patients to evaluate the self-reported QoL, 58% of patients showing an increase of EQ-5 VAS score at follow up compared to baseline (home treatment start) or remaining stable. A mild increase of average disease severity, measured through Mainz Severity Score Index (MSSI), was found during hospital treatment (p < 0,007), while it remained stable between the first home therapy infusion and last follow up. Interestingly, 4 out of 7 (57%) patients, showing an improvement in FD-related clinical status after starting home therapy, had previously a sub-optimal compliance to treatment during the period of hospital treatment management. Only 4 adverse non serious reactions (0,093%) were reported totally in 2 patients during home treatment. We conclude that home infusions in eligible patients with FD are safe, contribute to improve treatment compliance and therapeutic clinical outcomes, and may have a positive impact on self-perceived QoL.
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Affiliation(s)
- D. Concolino
- Department of Medical and Surgical Science, Pediatric Unit, University “Magna Graecia”, Catanzaro, Italy
- Corresponding author at: Department Medical and Surgical Science, Pediatric Unit, University “Magna Graecia” of Catanzaro, “Pugliese-Ciaccio” Hospital, Viale Pio X, 88100 Catanzaro, Italy.Department Medical and Surgical SciencePediatric UnitUniversity “Magna Graecia” of Catanzaro“Pugliese-Ciaccio” HospitalViale Pio XCatanzaro88100Italy
| | - L. Amico
- Nephrology Unit, Ospedali Riuniti Villa Sofia, Cervello, Palermo, Italy
| | - M.D. Cappellini
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E. Cassinerio
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Conti
- Nephrology Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - M.A. Donati
- Metabolic and Neuromuscular Unit, AOU Meyer Hospital, Florence, Italy
| | - F. Falvo
- Department of Medical and Surgical Science, Pediatric Unit, University “Magna Graecia”, Catanzaro, Italy
| | - A. Fiumara
- Regional Referral Center for Inborn Errors Metabolism, Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, Catania, Italy
| | - M. Maccarone
- Nephrology and Dialysis Unit, Ospedale di Lanciano, Chieti, Italy
| | - R. Manna
- Periodic Fevers Research and Rare Diseases Centre, Internal Medicine Department, Policlinico Gemelli, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - A. Matucci
- SOD Immunoallergologia, AOU Careggi, Firenze, Italy
| | - M.B. Musumeci
- Sapienza University, Department of Molecular and Clinical Medicine, Cardiology, Sant'Andrea Hospital, Rome, Italy
| | - A. Nicoletti
- Department of Medical and Surgical Science, Pediatric Unit, University “Magna Graecia”, Catanzaro, Italy
| | - R. Nisticò
- Neuroimaging Research Unit, Institute of Bioimaging and Molecular Physiology, National Research Council, Germaneto, Catanzaro, Italy
| | - F. Papadia
- U.O.C. Malattie Metaboliche Genetica Medica, PO Giovanni XXIII, A.O.U. Policlinico Consorziale, Bari, Italy
| | - R. Parini
- UOS Malattie Metaboliche Rare, Clinica Pediatrica, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - D. Peluso
- Neurology Unit, Azienda Ospedaliera S. Carlo, Potenza, Italy
| | - L. Pensabene
- Department of Medical and Surgical Science, Pediatric Unit, University “Magna Graecia”, Catanzaro, Italy
| | - A. Pisani
- Renal Unit, Department of Public Health, “Federico II” University, Naples, Italy
| | - G. Pistone
- UOC Dermatologia e MTS Dipartimento DIBIMIS AOUP “Paolo Giaccone” Palermo, Italy
| | - M. Rigoldi
- Dept. of Internal Medicine, San Gerardo Hospital, Monza, Italy
| | - I. Romani
- NEUROFARBA Department, University of Florence, V.le Pieraccini 6, 50139 Florence, Italy
| | - M. Tenuta
- Neurology Unit, Azienda Ospedaliera Universitaria S. G. di Dio e Ruggi D'Aragona, Salerno, Italy
| | - G. Torti
- Clinica Nefrologica, Ospedale San Gerardo, Monza, Italy
| | - M. Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical, Surgery Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy
| | - E. Zachara
- U.O.C. Cardiologia 2, Ospedale San Camillo-Forlanini, Rome, Italy
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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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Freedman R, Sahhar M, Curnow L, Lee J, Peters H. Receiving enzyme replacement therapy for a lysosomal storage disorder: a preliminary exploration of the experiences of young patients and their families. J Genet Couns 2013; 22:517-32. [PMID: 23536258 DOI: 10.1007/s10897-013-9579-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
Medical intervention for lysosomal storage disorders becomes part of life, shaping the reality of the condition for affected individuals and families. Enzyme replacement therapy (ERT) is available to treat some lysosomal storage disorders. ERT is costly and time consuming, requiring frequent hospital visits to receive intravenous infusions. This qualitative study sought to explore the impact of receiving ERT for a lysosomal storage disorder on the health related quality of life (HRQoL) of young patients and their families. Fifteen semi-structured interviews were conducted with young people and parents and siblings of young people accessing ERT for Pompe disease, Gaucher disease or mucopolysaccharidosis types I or II living in Victoria, Australia. Interviews were transcribed then analyzed thematically. The biopsychosocial model assisted in interpreting themes. Findings revealed positive attitudes towards ERT, with noticed improvements in physical and psychosocial well-being. Participants prioritised intervention over other activities and provided suggestions for improving current service delivery. Communication with family members and professionals was deemed important, especially in respect to information provision. Participants described challenges associated with living with a lysosomal storage disorder and receiving ERT and coping strategies, such as positive thinking and ways to manage uncertainty. These findings provide valuable insights into the impact of living with a chronic genetic condition and receiving intensive treatment on HRQoL.
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Affiliation(s)
- R Freedman
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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Parini R, Feriozzi S. Females and children with Anderson–Fabry disease: diagnosis, monitoring, benefits of enzyme replacement therapy (ERT) and considerations on timing of starting ERT. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.776957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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10
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Smid BE, Hoogendijk SL, Wijburg FA, Hollak CEM, Linthorst GE. A revised home treatment algorithm for Fabry disease: influence of antibody formation. Mol Genet Metab 2013; 108:132-7. [PMID: 23332169 DOI: 10.1016/j.ymgme.2012.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/19/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Enzyme replacement therapy for Fabry disease, consisting of biweekly infusions, interferes daily life. Home treatment proved beneficial. We evaluated a previously reported home treatment algorithm aiming to shorten the period of in-hospital infusions, while ascertaining patient safety. METHODS Retrospective analysis on clinical records of treated Fabry patients. Potentially predictive factors for infusion associated reactions (IARs) were studied: agalsidase antibodies, agalsidase product and dose, FOS-SSI scores, and GLA activity and mutation. A questionnaire evaluated patient satisfaction and compliance. RESULTS Seventy-nine patients were included (41 males, 46% agalsidase antibody positive (AB+)). 85% received home treatment. Home treatment complications were erroneous fast infusion rates (n=4) causing IARs and, rarely, venous access problems. The single SAE was unrelated to home treatment. IgG antibody status was significantly associated with IARs (89% vs. 26% p-value<0.01). Negative antibody status did not preclude IARs. Except for three AB+ patients, all first IARs occurred within 13 infusions. IARs occurred more frequently in patients using agalsidase beta 1.0 mg/kg/eow than agalsidase alpha or beta 0.2 mg/kg/eow, but the time to first IAR did not differ between groups. Four AB+ males experienced IARs after a dose increase. Compliance between home and in-hospital treatment was similar. Most patients preferred home treatment. CONCLUSION In this study home therapy for Fabry disease was safe and improved patient satisfaction. We propose a revised algorithm which allows safe home-treatment in all male patients after 13 instead of 26 infusions, irrespective of ERT preparation or dose. Furthermore, AB+ patients with dosage increase may experience new or increased IARs, necessitating in-hospital observations.
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Affiliation(s)
- B E Smid
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Academic Medical Centre, Amsterdam, The Netherlands.
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Scarpa M, Almássy Z, Beck M, Bodamer O, Bruce IA, De Meirleir L, Guffon N, Guillén-Navarro E, Hensman P, Jones S, Kamin W, Kampmann C, Lampe C, Lavery CA, Teles EL, Link B, Lund AM, Malm G, Pitz S, Rothera M, Stewart C, Tylki-Szymańska A, van der Ploeg A, Walker R, Zeman J, Wraith JE. Mucopolysaccharidosis type II: European recommendations for the diagnosis and multidisciplinary management of a rare disease. Orphanet J Rare Dis 2011; 6:72. [PMID: 22059643 PMCID: PMC3223498 DOI: 10.1186/1750-1172-6-72] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 11/07/2011] [Indexed: 01/09/2023] Open
Abstract
Mucopolysaccharidosis type II (MPS II) is a rare, life-limiting, X-linked recessive disease characterised by deficiency of the lysosomal enzyme iduronate-2-sulfatase. Consequent accumulation of glycosaminoglycans leads to pathological changes in multiple body systems. Age at onset, signs and symptoms, and disease progression are heterogeneous, and patients may present with many different manifestations to a wide range of specialists. Expertise in diagnosing and managing MPS II varies widely between countries, and substantial delays between disease onset and diagnosis can occur. In recent years, disease-specific treatments such as enzyme replacement therapy and stem cell transplantation have helped to address the underlying enzyme deficiency in patients with MPS II. However, the multisystem nature of this disorder and the irreversibility of some manifestations mean that most patients require substantial medical support from many different specialists, even if they are receiving treatment. This article presents an overview of how to recognise, diagnose, and care for patients with MPS II. Particular focus is given to the multidisciplinary nature of patient management, which requires input from paediatricians, specialist nurses, otorhinolaryngologists, orthopaedic surgeons, ophthalmologists, cardiologists, pneumologists, anaesthesiologists, neurologists, physiotherapists, occupational therapists, speech therapists, psychologists, social workers, homecare companies and patient societies. Take-home message Expertise in recognising and treating patients with MPS II varies widely between countries. This article presents pan-European recommendations for the diagnosis and management of this life-limiting disease.
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Abstract
Fabry disease is an X-linked lysosomal storage disorder that is caused by a deficiency in the enzyme α-galactosidase A. Manifestations emerge during childhood, including neuropathic pain, hypohidrosis and gastrointestinal problems. Major organ involvement typically occurs during adulthood and includes progressive kidney dysfunction, cardiomyopathy and valve disease, and stroke. Enzyme-replacement therapy with agalsidase alfa has been available since 2001 and is associated with clinical benefit in adult men and women, as well as in children, with Fabry disease. The responses to agalsidase alfa include reduction in the severity of neuropathic pain, stabilization of kidney function and reduction in left ventricular mass in patients with baseline left ventricular hypertrophy. Several issues, including when to initiate treatment and whether long-term treatment will extend survival, remain to be answered. This article covers the clinical development of agalsidase alfa and the postmarketing reports of its safety and effectiveness.
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Affiliation(s)
- Atul Mehta
- a Royal Free Hospital and University College Medical School, Pond Street, NW3 2QG, London, UK.
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Salviati A, Burlina AP, Borsini W. Nervous system and Fabry disease, from symptoms to diagnosis: damage evaluation and follow-up in adult patients, enzyme replacement, and support therapy. Neurol Sci 2010; 31:299-306. [PMID: 20300794 PMCID: PMC2869001 DOI: 10.1007/s10072-009-0211-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 12/16/2009] [Indexed: 01/07/2023]
Abstract
The X-linked genetic Fabry disease causes multiorgan lesions due to intracellular storage of the substrate globotriaosylceramide. Neurological involvement ranges from painful, small fiber neuropathy to cerebrovascular disorders to multifocal aggressive forms. Disease identification through proper differential diagnosis and timely assessment of organ damage should guide a careful treatment planning. Mainstay treatment, include enzyme replacement and support therapy. Neurologists have a pivotal role in early instrumental and clinical detection of organ damage. A panel of experts has developed a set of consensus recommendations to guide the approach of neurologists to Fabry disease.
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Affiliation(s)
- Alessandro Salviati
- Section of Clinical Neurology, Department of Neurological Sciences and Vision, University Hospital, Verona, Italy
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Little C, Gould R, Hendriksz C. The management of children with Hunter syndrome – a case study. ACTA ACUST UNITED AC 2009; 18:321-2. [DOI: 10.12968/bjon.2009.18.5.40546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine Little
- Clinical Inherited Metabolic Disorders, Birmingham Children’s Hospital, Birmingham
| | | | - Chris Hendriksz
- Inherited Metabolic Disorders Clinical Inherited Metabolic Disorders, Birmingham Children’s Hospital, Birmingham
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Cousins AJ. Improving compliance and quality of life with home infusions for the treatment of fabry disease. Clin Ther 2009. [DOI: 10.1016/s0149-2918(09)00242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bagewadi S, Roberts J, Mercer J, Jones S, Stephenson J, Wraith JE. Home treatment with Elaprase and Naglazyme is safe in patients with mucopolysaccharidoses types II and VI, respectively. J Inherit Metab Dis 2008; 31:733-7. [PMID: 18923918 DOI: 10.1007/s10545-008-0980-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 07/24/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
Abstract
Enzyme replacement therapy for lysosomal storage disorders has made an important contribution to improving the quality of life of affected patients. The treatment, however, is invasive and onerous, involving weekly or biweekly intravenous infusions of product over a 3-4 h period. Such therapy can be extremely disruptive of normal family life and the provision of a safe, home treatment regimen is greatly appreciated by affected families. In this report we demonstrate the safety of home treatment with Elaprase for mucopolysaccharidosis type II (17 patients) and Naglazyme for mucopolysaccharidosis type VI (6 patients). Careful patient selection, an experienced home care company and a detailed management plan for potential anaphylaxis and infusion-associated reactions are important components in a successful home treatment programme.
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Affiliation(s)
- S Bagewadi
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, Manchester, M27 4HA, UK
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