Considerations for Home-Based Treatment of Fabry Disease in Poland during the COVID-19 Pandemic and Beyond

The patients` perspective on home-based infusion: A longitudinal observational study in the German healthcare setting for patients with lysosomal storage disorders treated with enzyme replacement therapy

Background

Lysosomal storage diseases (LSDs), metabolic disorders resulting in build-up of endogenous waste and progressive organ damage, can be treated with intravenous enzyme replacement therapy (ERT). ERT can be administered either in specialized clinics, at a physician's office or in the home care setting. Legislative goals in Germany strive to shift to more outpatient care while maintaining treatment objectives. This study investigates the patient perspective on home-based ERT in terms of acceptance, safety, and treatment satisfaction in LSD patients.

Methods

This was a longitudinal observational study, carried out under real-world conditions in patients' home environment, covering 30 months from January 2019 to June 2021. Patients with LSDs who were deemed suitable for home-based ERT by their physicians were recruited to the study. Patients were interviewed before the start of the first home-based ERT and then at regular intervals thereafter using standardized questionnaires.

Results

Data from 30 patients were analyzed: 18 with Fabry disease, 5 with Gaucher disease, 6 with Pompe disease and 1 with Mucopolysaccharidosis type I (MPS I). Age ranged from 8 to 77 years (mean age 40). The reported average waiting time prior to infusion of more than half an hour decreased from 30% of the patients affected at baseline to 5% across all follow-up time points. All patients felt adequately informed about home-based ERT throughout follow-ups and reported that they would choose home-based ERT again. At almost each time point, patients indicated that home-based ERT had improved their ability to cope with the disease. All but one patient indicated feeling safe at each follow-up time point. Compared to 36.7% at baseline, only 6.9% of patients reported a need for improvement in their care after 6 months of home-based ERT. Mean treatment satisfaction increased by approximately 1.6 scale points after 6 months of home-based ERT compared to baseline, and by another 0.2 scale points after 18 months. In terms of quality of care, all but one patient rated home-based ERT as an equivalent alternative throughout follow-ups. Patients would recommend home-based ERT to other suitable LSD-patients.

Conclusion

Home-based ERT increases patients' treatment satisfaction, and patients perceive the quality of care as an equivalent alternative, compared to ERT in a center, clinic, or at a physician's office.

Transitions of Care in Cystic Fibrosis

The development of formal transition models emerged to reduce variability in care, including cystic fibrosis (CF) responsibility, independence, self-care, and education (RISE), which provides a standardized transition program, including knowledge assessments, self-management checklists, and milestones for people with CF. Despite these interventions, the current landscape of health care transition (HCT) remains suboptimal, and additional focused attention on HCT is necessary. Standardization of assessment tools to gauge the efficacy of transfer from pediatric to adult care is a high priority. Such tools should incorporate both clinical and patient-centered outcomes to provide a comprehensive picture of progress and deficiencies of the HCT process.

The impact of the COVID-19 pandemic on Fabry Disease Patients: an examination of Mood Status, Therapy Adherence, and COVID-19 infection

BACKGROUND

Fabry disease (FD) is a rare metabolic disorder, in which a lifelong enzyme replacement therapy (ERT) constitutes the cornerstone of disease-specific therapy. In this study, we examined the effects of the COVID-19 pandemic and lockdown measures on the management of FD patients.

METHODS

We collected data in three main domains; mood status, adherence to ERT, and COVID-19 infection. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate the mood statuses of FD patients and the Morisky Medication Adherence Scale (MMAS) and the Medication Adherence Report Scale (MARS) to assess patients' adherence to non-disease specific therapy. We also examined a control group to compare the mood status data.

RESULTS

A total of 67 FD patients (males: 47.8%, mean age: 37.0 years) were recruited to the study, of which 58 were receiving ERT. Both the HADS depression and anxiety scores were higher in the control group compared to FD patients. During the first wave of the pandemic, 25 patients reported to have missed an infusion for a mean of 2.3 ± 1.7 doses and half of the patients had adopted a home-based infusion treatment regimen. COVID-19 infection developed in 25 patients, of which one died. The majority of our patients (71.6%) have had at least one shot of the vaccine.

CONCLUSION

We found that FD patients were more resilient to the negative psychological effects of lockdown. Traumatic growth may be an important factor in explaining this finding. Government-supported home therapy programs might be beneficial for FD patients to increase the therapy adherence.

Fabry Disease in Slovakia: How the Situation Has Changed over 20 Years of Treatment

Fabry disease (FD, OMIM#301500) is a rare inborn error of the lysosomal enzyme α-galactosidase (α-Gal A, EC 3.2.1.22) and results in progressive substrate accumulation in tissues with a wide range of clinical presentations. Despite the X-linked inheritance, heterozygous females may also be affected. Hemizygous males are usually affected more severely, with an earlier manifestation of the symptoms. Rising awareness among health care professionals and more accessible diagnostics have positioned FD among the most-common inherited metabolic diseases in adults. An early and correct diagnosis of FD is crucial with a focus on personalised therapy. Preventing irreversible destruction of vital organs is the main goal of modern medicine. The aim of this study was to offer a complex report mapping the situation surrounding FD patients in Slovakia. A total of 48 patients (21 males, 27 females) with FD are registered in the Centre for Inborn Errors of Metabolism in Bratislava, Slovakia. In our cohort, we have identified three novel pathogenic variants in five patients. Three patients presented with the frameshift mutation c.736delA, and two others presented with the missense mutations c.203T>C, c.157A>C. Moreover, we present a new clinical picture of the pathogenic variant c.801+1G>A, which was previously described and associated with the renal phenotype.