Agalsidase alfa and kidney dysfunction in Fabry disease.
In male patients with Fabry disease, an X-linked disorder of glycosphingolipid metabolism caused by deficient activity of the lysosomal enzyme alpha-galactosidase A, kidney dysfunction becomes apparent by the third decade of life and invariably progresses to ESRD without treatment. Here, we summarize the effects of agalsidase alfa on kidney function from three prospective, randomized, placebo-controlled trials and their open-label extension studies involving 108 adult male patients. The mean baseline GFR among 54 nonhyperfiltrating patients (measured GFR <135 ml/min per 1.73 m(2)) treated with placebo was 85.4 +/- 29.6 ml/min per 1.73 m(2); during 6 mo of placebo, the mean annualized rate of change in GFR was -7.0 +/- 32.9 ml/min per 1.73 m(2). Among 85 nonhyperfiltrating patients treated with agalsidase alfa, the annualized rate of change was -2.9 +/- 8.7 ml/min per 1.73 m(2). Treatment with agalsidase alfa did not affect proteinuria. Multivariate analysis revealed that GFR and proteinuria category (< 1 or > or = 1 g/d) at baseline significantly predicted the rate of decline of GFR during treatment. This summary represents the largest group of male patients who had Fabry disease and for whom the effects of enzyme replacement therapy on kidney function have been studied. These data suggest that agalsidase alfa may stabilize kidney function in these patients.
Division of Nephrology, Department of Medicine, Dalhousie University, 5090 ACC QE II Health Sciences Centre, 5820 University Avenue, Halifax, NS, Canada B3H 1V8. mlwest@dal.ca
Michael
M
West
Kathy
K
Nicholls
Atul
A
Mehta
Joe T R
JT
Clarke
Robert
R
Steiner
Michael
M
Beck
Bruce A
BA
Barshop
William
W
Rhead
Robert
R
Mensah
Markus
M
Ries
Raphael
R
Schiffmann
D000328:Adult; D000795:Fabry Disease / Q000188:drug therapy / Q000201:enzymology* / Q000503:physiopathology*; D005919:Glomerular Filtration Rate; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism / Q000627:therapeutic use; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D011507:Proteinuria / Q000209:etiology; D011994:Recombinant Proteins; D017582:Renal Replacement Therapy / Q000379:methods*; D016896:Treatment Outcome; D000519:alpha-Galactosidase / Q000378:metabolism / Q000627:therapeutic use*
D007527:Isoenzymes; D011994:Recombinant Proteins; C000627036:agalsidase alfa; D000519:alpha-Galactosidase