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Previous Volume 345:9-16 July 5, 2001 Number 1 Next

Safety and Efficacy of Recombinant Human -Galactosidase A Replacement Therapy in Fabry's Disease

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ABSTRACT

Background Fabry's disease, lysosomal -galactosidase A deficiency, results from the progressive accumulation of globotriaosylceramide and related glycosphingolipids. Affected patients have microvascular disease of the kidneys, heart, and brain.

Methods We evaluated the safety and effectiveness of recombinant -galactosidase A in a multicenter, randomized, placebo-controlled, double-blind study of 58 patients who were treated every 2 weeks for 20 weeks. Thereafter, all patients received recombinant -galactosidase A in an open-label extension study. The primary efficacy end point was the percentage of patients in whom renal microvascular endothelial deposits of globotriaosylceramide were cleared (reduced to normal or near-normal levels). We also evaluated the histologic clearance of microvascular endothelial deposits of globotriaosylceramide in the endomyocardium and skin, as well as changes in the level of pain and the quality of life.

Results In the double-blind study, 20 of the 29 patients in the recombinant -galactosidase A group (69 percent) had no microvascular endothelial deposits of globotriaosylceramide after 20 weeks, as compared with none of the 29 patients in the placebo group (P<0.001). Patients in the recombinant -galactosidase A group also had decreased microvascular endothelial deposits of globotriaosylceramide in the skin (P<0.001) and heart (P<0.001). Plasma levels of globotriaosylceramide were directly correlated with clearance of the microvascular deposits. After six months of open-label therapy, all patients in the former placebo group and 98 percent of patients in the former recombinant -galactosidase A group who had biopsies had clearance of microvascular endothelial deposits of globotriaosylceramide. Mild-to-moderate infusion reactions (i.e., rigors and fever) were more common in the recombinant -galactosidase A group than in the placebo group.

Conclusions Recombinant -galactosidase A replacement therapy cleared microvascular endothelial deposits of globotriaosylceramide from the kidneys, heart, and skin in patients with Fabry's disease, reversing the pathogenesis of the chief clinical manifestations of this disease.

Source Information

From the Mount Sinai School of Medicine, New York (C.M.E., R.J.D.); Hôpital Edouard Herriot, Lyons, France (N.G.); Cedars–Sinai Burns and Allen Research Institute, UCLA School of Medicine, Los Angeles (W.R.W.); Hôpital Européen Georges Pompidou, Paris (D.P.G.); University College London Hospitals, London (P.L.); Hope Hospital, Salford, Manchester, United Kingdom (S.W.); Beth Israel Deaconess Medical Center, Boston (L.C.); and Academisch Medisch Centrum, Amsterdam (G.E.L.).

Address reprint requests to Dr. Desnick at the Department of Human Genetics, Box 1498, Mount Sinai School of Medicine, Fifth Ave. at 100th St., New York, NY 10029, or at rjd.fabry{at}mssm.edu.

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