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Serrano-Gonzalo I, de Frutos LL, Lahoz-Gil C, Delgado-Mateos F, Fernández-Galán MÁ, Morales-Conejo M, Calle-Gordo MV, Ibarretxe-Gerediaga D, Madinaveitia-Ochoa A, Albarracin-Arraigosa A, Balanzat-Muñoz J, Correcher-Medina P, García-Frade LJ, Hernández-Rivas JM, Labbadia F, López-Dupla JM, Lozano-Almela ML, Mora-Casterá E, Noya-Pereira MS, Ruíz-Guinaldo MÁ, Del Mar Tormo-Díaz M, Vitoria-Miñana I, Arévalo-Vargas I, Andrade-Campos M, Giraldo P. Real life data: follow-up assessment on Spanish Gaucher disease patients treated with eliglustat. TRAZELGA project. Orphanet J Rare Dis 2023; 18:390. [PMID: 38102667 PMCID: PMC10722815 DOI: 10.1186/s13023-023-02939-4] [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: 03/09/2023] [Accepted: 10/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The availability of multiple treatments for type 1 Gaucher disease increases the need for real-life studies to evaluate treatment efficacy and safety and provide clinicians with more information to choose the best personalized therapy for their patients. AIMS To determine whether treatment with eliglustat produces, in adult GD1 patients, ans optimal response in daily clinical practice. METHODS We designed a real-life study with 2 years of follow-up (TRAZELGA [GEE-ELI-2017-01]) to uniformly evaluate the response and adverse events to eliglustat treatment. This study, conducted in 30 patients across Spain and previously treated with other therapies, included the evaluation of safety and efficacy by assessing visceral enlargement, bone disease (DEXA and T and Z scores), concomitant treatments and adverse events, as well as a quality of life evaluation (SF-36). In addition, the quantification of classical biomarkers (chitotriosidase activity, CCL18/PARC and glucosylsphingosine (GluSph)) and new candidates for GD biomarkers (YKL-40, cathepsin S, hepcidin and lipocalin-2 determined by immunoassay) were also assessed. Non-parametric statistical analysis was performed and p < 0.05 was considered statistically significant. MAIN RESULTS Thirty patients were enrolled in the study. The median age was 41.5 years and the male-female ratio was 1.1:1. 84% of the patients had received ERT and 16% SRT as previous treatment. The most common symptoms at baseline were fatigue (42%) and bone pain (38%), no patient had a bone crisis during the study, and two years after switching, 37% had reduced their use of analgesics. Patient-reported outcomes showed a significant increase in physical function scores (p = 0.027) and physical pain scores (p = 0.010). None of the enrolled patients discontinued treatment due to adverse events, which were mild and transient in nature, mainly gastrointestinal and skin dryness. None of the biomarkers show a significant increase or decompensation after switching. CCL18/PARC (p = 0.0012), YKL-40 (p = 0.00004) and lipocalin-2 (p = 0.0155) improved after two years and GluSph after one year (p = 0.0008) and two years (p = 0.0245) of oral therapy. CONCLUSION In summary, this real-life study, showed that eliglustat maintains stability and can improve quality of life with few side effects. Significant reductions in classic and other novel biomarkers were observed after two years of therapy.
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Affiliation(s)
- Irene Serrano-Gonzalo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo de Investigación de Enfermedad de Gaucher (GIIS-012), Instituto de Investigación Sanitaria de Aragón, Saragossa, Spain
| | - Laura López de Frutos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
| | - Carlos Lahoz-Gil
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
| | - Francisco Delgado-Mateos
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Punta de Europa, Cádiz, Spain
| | - María Ángeles Fernández-Galán
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Virgen del Puerto, Plasencia, Spain
| | | | - María Victoria Calle-Gordo
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital de Torrecardenas, Almería, Spain
| | - Daiana Ibarretxe-Gerediaga
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari San Joan, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | | | | | - José Balanzat-Muñoz
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Can Misses, Ibiza, Spain
| | | | - Luis Javier García-Frade
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Jesús María Hernández-Rivas
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Departamento de Medicina, Universidad de Salamanca and Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesca Labbadia
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital de La Vega Lorenzo Guirao, Murcia, Spain
| | | | - María Luisa Lozano-Almela
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital General Universitario Morales Meseguer, IMIB-Pascual Parrilla, CIBERER-U765, Murcia, Spain
| | - Elvira Mora-Casterá
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Soledad Noya-Pereira
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Teresa Herrera, A Coruña, Spain
| | - María Ángeles Ruíz-Guinaldo
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Comarcal Francesc de Borja, Valencia, Spain
| | - María Del Mar Tormo-Díaz
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Isidro Vitoria-Miñana
- Unidad de Nutrición y Metabolopatías, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isidro Arévalo-Vargas
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo de Investigación de Enfermedad de Gaucher (GIIS-012), Instituto de Investigación Sanitaria de Aragón, Saragossa, Spain
| | - Marcio Andrade-Campos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
| | - Pilar Giraldo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain.
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain.
- Servicio de Hematología, Hospital QuirónSalud, Saragossa, Spain.
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Camou F, Lagadec A, Coutinho A, Berger MG, Cador-Rousseau B, Gaches F, Belmatoug N. Patient reported outcomes of patients with Gaucher disease type 1 treated with eliglustat in real-world settings: The ELIPRO study. Mol Genet Metab 2023; 140:107667. [PMID: 37597334 DOI: 10.1016/j.ymgme.2023.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Gaucher disease type 1 (GD1) is a rare genetic lysosomal storage disorder. Eliglustat is a first-line oral therapy for adult patients with GD1. The aim of the ELIPRO (ELIglustat Patient Reported Outcomes) study was to assess real-world outcomes of eliglustat treatment for over 1 year in patients with GD1, with a focus on patient-reported outcomes (PROs), including treatment adherence. METHODS This was a non-interventional, prospective, multicentric study. Patients were stratified according to their previous time on eliglustat: >6 months (Group1) and ≤ 6 months (Group2). The primary endpoint was adherence to eliglustat, measured by the eight-items Morisky Medication Adherence Scale (MMAS-8; scale of 0-8) at 6 months in Group2. Secondary endpoints were quality of life (QoL) measured by patient input using the European Quality of Life five-dimensional three-level [EQ-5D-3L] questionnaire, fatigue and pain measured by numeric rating scale [NRS; on a scale of 0-10], the evaluation of patient satisfaction level regarding eliglustat treatment measured by Likert scale [scale of 0-7] and treatment adherence at 12 months in both groups. The study also evaluated the safety and effectiveness of eliglustat in the adult GD1 population. RESULTS Sixty patients with GD1 (approximatively 52% male, mean age: 46.6 ± 13.9 years) were analyzed: 29 in Group1 and 31 in Group2. GD1 was mostly of mild severity (90%) and 95% of patients had extensive CYP2D6 metabolizer phenotype. Fifty-seven patients had previously received treatment for GD1 (91% enzyme replacement therapy) and 15% were splenectomized. Groups1 and 2 were not necessarily matching for all characteristics. At 6 months, 58% of Group2 patients showed medium adherence (6 < MMAS-8 < 7.75) while 21% showed high adherence (MMAS-8: 8) (mean MMAS-8: 6.7 ± 1.0); similar results were obtained in Group1 (50% showed high compliance, 35% showed medium compliance; mean MMAS-8: 6.8 ± 1.4). The mean MMAS-8 for Group1 and Group2 were 7.1 ± 1.2 (vs 7.0 ± 1.0 at baseline) and 6.5 ± 1.0, respectively, at 12 months. At 12 months, the mean NRS scores in Group1 and Group2 were 72.0 ± 18.5 and 77.3 ± 13.7 for QoL (vs. 71.7 ± 18.4 and 80.2 ± 12.4, respectively at baseline), 4.8 ± 2.6 and 3.6 ± 2.7 for fatigue (vs. 4.6 ± 2.7 and 3.6 ± 2.6, respectively at baseline) and 3.3 ± 2.7 and 2.3 ± 2.3 for pain (vs. 3.3 ± 2.7 and 2.0 ± 2.4, respectively at baseline). GD1 assessments (biological, clinical and imaging parameters) remained stable during 12 months in both groups. At the end of the study, majority (97.4%) of patients were satisfied with their treatment with eliglustat (satisfaction score over 5 out of 7). Sixty-six percent of patients (n = 41) experienced mostly mild adverse events (AE) (including four study withdrawals), of whom 27.4% (n = 17) of patients experienced eliglustat-related AEs. Treatment adherence remained stable during 12 months in both groups. CONCLUSIONS Eliglustat treatment compliance was good and sustained, along with overall health state, fatigue and pain levels, which was consistent with overall patients' clinical status. Eliglustat was well tolerated, and had a good safety profile, aligned with a good patient satisfaction. Our study should encourage greater use of PROs for evaluation of impact of the GD treatment on patient's symptoms and well-being.
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Affiliation(s)
| | | | - Angela Coutinho
- Vaincre les Maladies Lysosomales Patient Association, Massy, France
| | - Marc G Berger
- CHU Clermont-Ferrand, Hematology department, and EA 7453 CHELTER, University Clermont Auvergne, Clermont-Ferrand, France
| | | | | | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, Paris Cité University, APHP-Nord, France
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Duminuco A, Fazio M, Grasso S, Gullo L, Riccobene C, Calafiore V, Markovic U, Di Raimondo F, Giuffrida G. Effectiveness and Safety of Eliglustat Treatment in Gaucher Disease: Real-life Unicentric Experience. Clin Ther 2023; 45:1105-1110. [PMID: 37722956 DOI: 10.1016/j.clinthera.2023.08.010] [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: 05/24/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The therapy and management of Gaucher disease (GD) have radically changed with the use of substrate reduction therapy, of which eliglustat is the most widely known drug, allowing it to overcome the limits of enzyme replacement therapy (ERT). The rarity of GD and the limited use of eliglustat outside clinical trials require further study of its strengths and weaknesses. METHODS In this study, we evaluated the effectiveness and safety of eliglustat in a cohort of 12 patients with GD followed up in our center, reporting a reduction in both chitotriosidase (394.3 vs 181.1 nmol/h/mL, P = 0.027) and glucosylsphingosine values (45.1 vs 18.9 ng/mL, P <0.001) after at least 12 months of therapy compared with baseline, regardless of patient demographic characteristics and GD characteristics. FINDINGS There were no drug-related serious adverse effects and no drug-related cardiac events. Most adverse events were mild and transient, mainly dyspepsia and abdominal pain. Of interest, we reported an absence of statistical difference in terms of response regarding glucosylsphingosine reduction in relation to naive or prior exposure to ERT (P = 0.296), which was confirmed also when patients were placed in naive and treated groups for <5 vs >5 years (P = 0.667). IMPLICATIONS The use of eliglustat immediately after diagnosis may guarantee the best treatment for patients with milder phenotypes or with aggressive disease after an initial stabilization with ERT compared with ERT, which cannot adequately remove the disease burden despite the apparent response, thus potentially reducing future complications caused by substrate deposits.
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Affiliation(s)
- Andrea Duminuco
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Manlio Fazio
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Stephanie Grasso
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Lara Gullo
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Carla Riccobene
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Valeria Calafiore
- U.O.C. Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Uros Markovic
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Francesco Di Raimondo
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy; Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, Catania, Italy
| | - Gaetano Giuffrida
- Hematology Unit with BMT, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy.
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Ellison S, Parker H, Bigger B. Advances in therapies for neurological lysosomal storage disorders. J Inherit Metab Dis 2023; 46:874-905. [PMID: 37078180 DOI: 10.1002/jimd.12615] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/21/2023]
Abstract
Lysosomal Storage Disorders (LSDs) are a diverse group of inherited, monogenic diseases caused by functional defects in specific lysosomal proteins. The lysosome is a cellular organelle that plays a critical role in catabolism of waste products and recycling of macromolecules in the body. Disruption to the normal function of the lysosome can result in the toxic accumulation of storage products, often leading to irreparable cellular damage and organ dysfunction followed by premature death. The majority of LSDs have no curative treatment, with many clinical subtypes presenting in early infancy and childhood. Over two-thirds of LSDs present with progressive neurodegeneration, often in combination with other debilitating peripheral symptoms. Consequently, there is a pressing unmet clinical need to develop new therapeutic interventions to treat these conditions. The blood-brain barrier is a crucial hurdle that needs to be overcome in order to effectively treat the central nervous system (CNS), adding considerable complexity to therapeutic design and delivery. Enzyme replacement therapy (ERT) treatments aimed at either direct injection into the brain, or using blood-brain barrier constructs are discussed, alongside more conventional substrate reduction and other drug-related therapies. Other promising strategies developed in recent years, include gene therapy technologies specifically tailored for more effectively targeting treatment to the CNS. Here, we discuss the most recent advances in CNS-targeted treatments for neurological LSDs with a particular emphasis on gene therapy-based modalities, such as Adeno-Associated Virus and haematopoietic stem cell gene therapy approaches that encouragingly, at the time of writing are being evaluated in LSD clinical trials in increasing numbers. If safety, efficacy and improved quality of life can be demonstrated, these therapies have the potential to be the new standard of care treatments for LSD patients.
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Affiliation(s)
- S Ellison
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - H Parker
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - B Bigger
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
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