title: Switching from immediate- to extended-release cysteamine in nephropathic cystinosis patients: a retrospective real-life single-center study.
abstract: Nephropathic cystinosis is a rare lysosomal storage disease which is characterized by the accumulation of free cystine in lysosomes and subsequent intracellular crystal formation of cystine throughout the body. If not treated with cysteamine, a cystine-depleting agent, end-stage renal disease will develop early, followed by multiple organ failure as the disease progresses. The established cysteamine formulation requires a strict dosing regimen at 6-h intervals. An extended release (ER) twice-daily formulation has recently been developed. The aim of our study was to evaluate the implementation and outcomes of this option in routine care.
  
  
  
  All pediatric cystinosis patients' records in Hannover Medical School were screened, and data on cysteamine therapy, tolerability, dosing, estimated glomerular filtration rates (eGFR), white blood cell cystine levels, and proton pump inhibitor (PPI) use were extracted for the period January 2014 to January 2016.
  
  
  
  The median age of the 12 patients enrolled in the study was 12.5 (range 1-18) years. At the end of the study period ten of these patients received ER-cysteamine. There were no additional side effects. Halitosis/bad breath was often subjectively judged as improved or eliminated, and PPI use could be stopped in one of three patients. The main reasons for switching to the ER formulation were difficult night-time administration and uncontrolled disease. Mean eGFR values remained stable with a median of 67 ml/min/1.73 m2before and after the transition. White blood cell (WBC) cystine values remained low after the switch (1 nmol/mg protein before and after transition; p = 0.64).
  
  
  
  In this single-center cohort, the switch from IR- to ER-cysteamine was safe and effective over the short term and provided advantages in terms of frequency of administration and less halitosis/bad breath. The long-term benefit of this option needs to be evaluated in future studies.
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Thurid
authors.initials: T
authors.lastname: Ahlenstiel-Grunow
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Nele K
authors.initials: NK
authors.lastname: Kanzelmeyer
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Froede
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kreuzer
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Drube
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Lerch
authors.affiliation: Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. Pape.Lars@mh-hannover.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003543:Cysteamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D003553:Cystine / Q000097:blood; D003554:Cystinosis / Q000188:drug therapy* / Q000209:etiology; D003692:Delayed-Action Preparations; D004339:Drug Compounding; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007962:Leukocytes / Q000378:metabolism; D008297:Male; D012076:Renal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D012076:Renal Agents; D003553:Cystine; D003543:Cysteamine
keywords: Cysteamine; Cystine depleting agents; Fanconi syndrome; Lysosomal storage disease; Nephropathic cystinosis