Therapeutic goals in the treatment of Fabry disease.
OBJECTIVE
Fabry disease is a progressive multiorgan, multisystem disorder that is caused by a deficiency in the lysosomal enzyme α-galactosidase A. Serious renal, cardiac, and cerebrovascular involvement are responsible for much of the morbidity and premature mortality associated with Fabry disease, and neuropathic pain, gastrointestinal problems, and hypohidrosis negatively affect quality of life of patients with Fabry disease. Fabry disease is X-linked, but women are often symptomatic and may be as severely affected as men.


METHODS
We propose a series of therapeutic and symptomatic goals for use in setting the expectations of enzyme replacement therapy and for assessing the response to enzyme replacement therapy in the treatment of Fabry disease.


RESULTS
Enzyme replacement therapy has been available since 2001 and has been associated with benefit in clinical trials, including stabilization of kidney function, improvement of cardiac structure and function, reduction in severity of neuropathic pain, and improvement in gastrointestinal involvement.


CONCLUSIONS
The presentation of these therapeutic goals will aid in the evaluation of response to enzyme replacement therapy and be useful in establishing an overall management plan for individual patients.
Mehta
Atul
A
The Royal Free Hospital, University College London School of Medicine, London, United Kingdom. Atul.mehta@royalfree.nhs.uk
West
Michael L
ML
Pintos-Morell
Guillem
G
Reisin
Ricardo
R
Nicholls
Kathy
K
Figuera
Luis E
LE
Parini
Rossella
R
Carvalho
Luiz R
LR
Kampmann
Christoph
C
Pastores
Gregory M
GM
Lidove
Olivier
O
D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology; D002986:Clinical Trials as Topic; D056947:Enzyme Replacement Therapy; D000795:Fabry Disease / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000209:etiology; D034381:Hearing Loss / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology; D008297:Male; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology; D011788:Quality of Life