Long-term effectiveness of enzyme replacement therapy in Fabry disease: results from the NCS-LSD cohort study.
OBJECTIVE
To determine the effectiveness of enzyme replacement therapy (ERT) for adults and children with Fabry disease.


METHODS
Cohort study including prospective and retrospective clinical data. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Treated patients contributed data before and during treatment and untreated patients contributed natural history data.


METHODS
Consenting adults (N = 289) and children (N = 22) with a confirmed diagnosis of Fabry disease attending a specialist Lysosomal Storage Disorder treatment centre in England. At recruitment 211 adults and seven children were on ERT (range of treatment duration, 0 to 9.7 and 0 to 4.2 years respectively).


METHODS
Clinical outcomes chosen to reflect disease progression included left ventricular mass index (LVMI); proteinuria; estimated glomerular filtration rate (eGFR); pain; hearing and transient ischaemic attacks (TIA)/stroke.


RESULTS
We found evidence of a statistically significant association between time on ERT and a small linear decrease in LVMI (p = 0.01); a reduction in the risk of proteinuria after adjusting for angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (p < 0.001) and a small increase in eGFR in men and women without pre-treatment proteinuria (p = 0.01 and p < 0.001 respectively). The same analyses in children provided no statistically significant results. No associations between time on ERT and pain, risk of needing a hearing aid, or risk of stroke or TIAs, were found.


CONCLUSIONS
These data provide some further evidence on the long-term effectiveness of ERT in adults with Fabry disease, but evidence of effectiveness could not be demonstrated in children.
Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, Devon, UK, EX2 4SG.
L J
LJ
Anderson
K M
KM
Wyatt
W
W
Henley
V
V
Nikolaou
S
S
Waldek
D A
DA
Hughes
G M
GM
Pastores
S
S
Logan
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004739:England; D056947:Enzyme Replacement Therapy / Q000379:methods*; D000795:Fabry Disease / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000150:complications; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome; D055815:Young Adult; D000519:alpha-Galactosidase / Q000627:therapeutic use*
D000519:alpha-Galactosidase