Safety of agalsidase alfa in patients with Fabry disease under 7 years.
OBJECTIVE
To evaluate the safety and explore the efficacy of enzyme replacement therapy (ERT) for Fabry disease with agalsidase alfa in young children enrolled in the Fabry Outcome Survey (FOS).


METHODS
This retrospective chart review identified eight children (mean age= 5.0±1.6 [mean ±SD]) in FOS who began treatment with agalsidase alfa (0.2 mg/kg, i.v., every other week) when <7 years old. Vital signs and adverse events were monitored throughout the study period. Glomerular filtration rate (GFR) was estimated, and left ventricular mass indexed to height(2.7) (LVMi) was assessed with echocardiography. Patients received 1.2-6.7 years of treatment (mean=4.2 years).


RESULTS
Infusion reactions occurred in three patients and were of mild or moderate severity. IgG antibodies to agalsidase alfa were found in one patient who experienced two mild and one moderate infusion reactions. Mean GFR was within the normal range at baseline and remained normal. LVMi was above the 75th percentile of age-matched children in 5 of 6 patients evaluated at baseline. Only two patients exceeded this threshold at their last assessment.


CONCLUSIONS
Long-term observation will be needed to determine whether early initiation of ERT will prevent major organ dysfunction in these patients.
Department of Paediatrics, Paediatric Metabolic Unit, Addenbrooke's Hospital, Cambridge, UK. uma.ramaswami@addenbrookes.nhs.uk
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Ramaswami
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Parini
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Kampmann
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Beck
D002648:Child; D002675:Child, Preschool; D003875:Drug Eruptions / Q000209:etiology; D056947:Enzyme Replacement Therapy / Q000009:adverse effects; D000795:Fabry Disease / Q000188:drug therapy* / Q000201:enzymology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced; D007074:Immunoglobulin G / Q000276:immunology; D007262:Infusions, Intravenous / Q000009:adverse effects; D007527:Isoenzymes / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D000519:alpha-Galactosidase / Q000009:adverse effects / Q000627:therapeutic use*
D007074:Immunoglobulin G; D007527:Isoenzymes; D011994:Recombinant Proteins; C000627036:agalsidase alfa; D000519:alpha-Galactosidase