title: An Audit of the Use of Gonadorelin Analogues to Prevent Recurrent Acute Symptoms in Patients with Acute Porphyria in the United Kingdom.
abstract: Severe recurrent acute attacks of porphyria have traditionally been treated with either prophylactic human haemin or gonadorelin analogues (GnA) in females. Evidence on the most effective treatment for this patient subgroup is lacking. This audit surveyed the use of prophylactic GnA in the UK.Twenty female patients (who experienced between 2 and 45 acute attacks of porphyria requiring hospitalisation and treatment with human haemin prior to GnA prophylaxis) were included in the audit. Data was retrospectively collected based on patient history and case review.Twenty three treatment courses were given lasting a median period of 12 months. Monthly subcutaneous Goserelin was most commonly used. In three patients in whom timing with the menstrual cycle was not considered, an acute attack occurred after initiation of the first dose. The majority of patients experienced oestrogen deficiency symptoms during treatment. Fifty percent of the prescribed courses of GnA resulted in a degree of clinical benefit. This successfully treated group experienced between 3 and 20 acute attacks prior to and between 0 and 6 acute attacks during GnA treatment.The audit revealed large variation in practice in the United Kingdom regarding indication, duration of treatment, specific drug used and management of side effects. In view of the limited treatment options available for this cohort and the mixed outcome successes reported, we believe it is reasonable for porphyria specialists to continue offering GnA treatment to women with severe recurrent debilitating acute attacks of porphyria associated with the menstrual cycle, and we propose best practice guidelines to standardise management.
authors.affiliation: Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, CF14 4XW, UK. Danja.Schulenburg-brand@wales.nhs.uk.
authors.forename: Danja
authors.initials: D
authors.lastname: Schulenburg-Brand
authors.affiliation: Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, CF14 4XW, UK.
authors.forename: Tricia
authors.initials: T
authors.lastname: Gardiner
authors.affiliation: Department of Haematological Medicine, King's College Hospital, London, SE5 9RS, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Guppy
authors.affiliation: Department of Haematological Medicine, King's College Hospital, London, SE5 9RS, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Rees
authors.affiliation: Department of Haematological Medicine, King's College Hospital, London, SE5 9RS, UK.
authors.forename: Penelope
authors.initials: P
authors.lastname: Stein
authors.affiliation: Department of Clinical Chemistry, Leeds General Infirmary, Leeds, LS1 3EX, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Barth
authors.affiliation: Manchester Academic Health Sciences Centre, Department of Clinical Biochemistry, Salford Royal NHS Foundation Trust, University of Manchester, Salford, M6 8HD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Felicity Stewart
authors.affiliation: Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, CF14 4XW, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Badminton