Earlier and higher dosing of alglucosidase alfa improve outcomes in patients with infantile-onset Pompe disease: Evidence from real-world experiences
Journal
Molecular Genetics and Metabolism Reports
Journal Volume
23
Pages
100591
Date Issued
2020
Author(s)
Tsai W.-H.
Chang C.-L.
Chiu P.-C.
Chou Y.-Y.
Tsai F.-J.
Wong S.-L.
Abstract
Objective: Enzyme replacement therapy (ERT), the only approved therapy for infantile-onset Pompe disease (IOPD), had heterogeneous clinical effects due to factors such as severity, age at first treatment, dosage, and dosing regimens. We report the clinical and biochemical outcomes of a cohort of IOPD patients identified through newborn screening, and evaluating the dosage effect. Study design: A retrospective observational study was designed to describe the long-term clinical and biochemical outcomes of a uniform cohort of IOPD patients who have been treated with high-dosage of ERT. Results: Twenty-eight patients received alglucosidase alpha at either the labeled dosage followed by a high dosage (n = 23) or a high dosage exclusively (n = 5). At a median age of 8.3 years (0.8–17.3), 15 patients were walkers, 8 were weak walkers, and 5 were nonwalkers. The three groups exhibited a significant difference in the age of gross motor decline (p < .001). In patients with classical IOPD diagnosed through newborn screening, those late in ERT initiation (p = .006) or late in high-dosage ERT initiation (p = .044) had a higher risk of motor decline. At the latest assessment, both serum creatine kinase (CK) and urinary glucose tetrasaccharide (uGlc4) levels were lowest in the walkers. During follow up, the biomarker levels, once rose, never returned to normal. Conclusion: Low CK and uGlc4 levels were correlated with favorable response to ERT in IOPD patients, although CK may be more fluctuated than uGlc4. High-dose ERT instituted immediately at newborn screening seems to give the best outcome, and a dosage increase is necessary upon – or, even better, before – a rise in biomarker levels. ? 2020 The Authors
SDGs
Other Subjects
alglucosidase alfa; creatine kinase; glucose; tetrasaccharide; adolescent; Article; child; clinical article; cohort analysis; creatine kinase blood level; enzyme replacement; follow up; glucose urine level; glycogen storage disease type 2; human; multicenter study (topic); newborn screening; observational study; onset age; retrospective study; treatment outcome; treatment response
Publisher
Elsevier Inc.
Type
journal article