Treatment of Fabry disease with different dosing regimens of agalsidase: effects on antibody formation and GL-3.
Two different enzyme preparations are used for the treatment of Fabry disease patients, agalsidase alpha (Replagal, Shire) and agalsidase beta (Fabrazyme, Genzyme). Therapeutic efficacy of both products has been variable probably due to differences in gender, severity, age and other patient characteristics. We studied the occurrence of alpha-Gal A antibodies and their effect on urinary and plasma globotriaosylceramide (GL-3), plasma chitotriosidase and clinical outcome in 52 patients after 12 months of treatment with either 0.2mg/kg agalsidase alppha (10 males, 8 females) or beta (8 males, 5 females) or 1.0mg/kg agalsidase beta (10 males, 11 females). Antibodies were detected in 18/28 male patients after 6 months. None of the females developed antibodies. Following 12 months of 0.2mg/kg treatment, urinary GL-3 decreased in antibody negative (AB-) but increased in antibody positive (AB+) patients. Treatment with 1.0mg/kg gave a reduction in urinary GL-3 in both AB- and AB+ patients. Levels of plasma GL-3 and chitotriosidase decreased in all patient groups. Twelve months of 0.2mg/kg treatment did not change renal function or left ventricular mass. Further, no change in renal function was seen following 1.0mg/kg treatment and left ventricular mass decreased in both AB- and AB+ patients. In summary, alpha-Gal A antibodies frequently develop in male Fabry disease patients and interfere with urinary GL-3 excretion. Infusion of a dose of 1.0mg/kg results in a more robust decline in GL-3, less impact, if any of antibodies, stable renal function and reduction of LVMass.
Vedder
Anouk C
AC
Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, F4-224, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Breunig
Frank
F
Donker-Koopman
Wilma E
WE
Mills
Kevin
K
Young
Elisabeth
E
Winchester
Bryan
B
Ten Berge
Ineke J M
IJ
Groener
Johanna E M
JE
Aerts
Johannes M F G
JM
Wanner
Christoph
C
Hollak
Carla E M
CE
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood / Q000494:pharmacology; D000917:Antibody Formation / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D000795:Fabry Disease / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000652:urine; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006596:Hexosaminidases / Q000378:metabolism; D006801:Humans; D006984:Hypertrophy / Q000139:chemically induced; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D014281:Trihexosylceramides / Q000097:blood / Q000378:metabolism* / Q000652:urine; D000519:alpha-Galactosidase / Q000008:administration & dosage* / Q000009:adverse effects / Q000037:antagonists & inhibitors / Q000276:immunology
D000906:Antibodies; D014281:Trihexosylceramides; C018549:globotriaosylceramide; D006596:Hexosaminidases; C086400:chitotriosidase; D000519:alpha-Galactosidase