title: The response of patients with phenylketonuria and elevated serum phenylalanine to treatment with oral sapropterin dihydrochloride (6R-tetrahydrobiopterin): a phase II, multicentre, open-label, screening study.
abstract: This study aimed to evaluate the response to and safety of an 8-day course of sapropterin dihydrochloride (6R-tetrahydrobiopterin or 6R-BH4) 10 mg/kg per day in patients with phenylketonuria (PKU), who have elevated blood phenylalanine (Phe) levels, and to identify a suitable cohort of patients who would respond to sapropterin dihydrochloride treatment with a reduction in blood Phe level. Eligible patients were aged > or = 8 years, had blood Phe levels > or = 450 micromol/L and were not adhering to a Phe-restricted diet. Suitable patients were identified by a > or = 30% reduction in blood Phe level from baseline to day 8 following sapropterin dihydrochloride treatment. The proportion of patients who met these criteria was calculated for the overall population and by baseline Phe level (< 600, 600 to < 900, 900 to < 1200 and > or = 1200 micromol/L). In total, 485/490 patients completed the study and 20% (96/485) were identified as patients who would respond to sapropterin dihydrochloride. A reduction in Phe level was observed in all subgroups, although response was greater in patients with lower baseline Phe levels. Wide variability in response was seen across all baseline Phe subgroups. The majority of adverse events were mild and all resolved without complications. Sapropterin dihydrochloride was well tolerated and reduced blood Phe levels across all PKU phenotypes tested. Variability in reduction of Phe indicates that the response to sapropterin dihydrochloride cannot be predicted by baseline Phe level.
authors.affiliation: Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. bburton@childrensmemorial.org
authors.forename: B K
authors.initials: BK
authors.lastname: Burton
authors.forename: D K
authors.initials: DK
authors.lastname: Grange
authors.forename: A
authors.initials: A
authors.lastname: Milanowski
authors.forename: G
authors.initials: G
authors.lastname: Vockley
authors.forename: F
authors.initials: F
authors.lastname: Feillet
authors.forename: E A
authors.initials: EA
authors.lastname: Crombez
authors.forename: V
authors.initials: V
authors.lastname: Abadie
authors.forename: C O
authors.initials: CO
authors.lastname: Harding
authors.forename: S
authors.initials: S
authors.lastname: Cederbaum
authors.forename: D
authors.initials: D
authors.lastname: Dobbelaere
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Dorenbaum
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001708:Biopterins / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002648:Child; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D010649:Phenylalanine / Q000097:blood*; D010661:Phenylketonurias / Q000097:blood / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D001708:Biopterins; D010649:Phenylalanine; C003402:sapropterin